Biology:2018 Nipah virus outbreak in Kerala

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2018 Nipah virus outbreak in Kerala
Nipah virus from an infected VERO cell.jpg
An electron micrograph of a Nipah virus
DiseaseNipah virus
Date2 May - 10 June 2018
Confirmed cases19
Deaths
17
Fatality rate89.4%

The 2018 Kerala Nipah virus outbreak was an outbreak of the Nipah virus in Kerala, traced to the fruit bats in the area. The outbreak was localized in Kozhikode and Malappuram districts of Kerala[1][2] and claimed 17 lives,[3][4] The outbreak was contained and declared over on 10 June 2018.[5] This was the third Nipah Virus outbreak in India, the earlier being in 2001 and 2007, both in the eastern state West Bengal.[6]

Timeline

The index case of the outbreak was reported at sub-divisional hospital in Perambra[7] in Kozhikode district on May 2.[8] This patient[7]—was later taken to the Government Medical College, Kozhikode for further treatment, where he later succumbed to the virus. Later, his brother Mohammed Salih was admitted to Baby Memorial Hospital, Kozhikode,[9] with suspected viral encephalitis. A team of doctors at Baby Memorial Hospital, Kozhikode suspected Nipah, as the symptoms were similar to that of his brother who had died by then. The samples were tested at the Manipal Institute of Virology where it was confirmed as a case of Nipah; samples were also tested positive at National Institute of Virology, Pune.

The index patient had passed the virus to 16 persons at Medical College Hospital; later two more were infected, increasing the total count of infected to 18. There were 10 deaths in the first week, including a nurse named Lini Puthussery who treated the index patient before diagnosis.[10][11] The outbreak began in Kozhikode district and later spread to the adjoining Malappuram district. Health advisories were issued for Northern Kerala as well as the adjoining districts of Karnataka, with two suspected cases detected in Mangalore on 23 May 2018.[12]

Over 2,000 people in Kozhikode and Malappuram districts were quarantined and kept under observation during the period of the outbreak.[13] To fight the outbreak, M 102.4—a human monoclonal antibody for which clinical trials are still going on—was imported from Australia .[14] This was facilitated by renowned Nipah researcher Christopher Broder.[15] The outbreak also lead to the revival of World Health Organization's Nipah Drug Trials Group, led by Soumya Swaminathan.

After Sabith, 16 of the affected patients succumbed to the disease and two patients recovered fully. The outbreak was officially declared over on 10 June 2018.[5]

Other Nipah outbreaks

A new case of a 23-year-old student was detected again on 4 June 2019 in Kochi.[16] Over 300 people were put under observation, but no further cases were reported. The student later recovered.[17] This is the fourth occurrence reported in India, with previous ones having occurred in 2001 (45 deaths), 2007 (5 deaths), and 2018 (17 deaths).[18][19]

Three years later, on September 5, 2021, a 12-year-old boy died of the Nipah virus in Pazhur, Kozhikode, prompting an investigation and the possibility of a new outbreak.[20]

Virology and epidemiology

The presence of the Nipah virus in patients was confirmed from RT-PCR tests conducted at the Manipal Institute of Virology and the National Virology Institute, Pune.[21]

Though the first set of samples did not detect the virus in bats,[22] later tests proved that fruit bats in the area were the source of the virus.[23]

Response

On 23 May 2018, Kerala Health Department issued a travel advisory asking travelers to the Northern districts of Kerala to be extra cautious.[24]

On 23 May 2018, State of Kerala, requesting medical advisory from Malaysian Health Department (Kementerian Kesihatan Malaysia), for treatment and medicines for Nipah virus.[1]

On 25 May 2018, sharing of Information of Virus was posted in the WHO EIS at Malaysian Time.[2] On the same day, the Ministry of Health and Prevention of the United Arab Emirates advised postponing unnecessary travel to Kerala and avoiding its fruits and vegetables until the situation was under control.[25]

On 30 May 2018 construction began on the Institute of Advanced Virology, Kerala,[26] which was founded in response to the outbreak.[27]

On 1 June 2018, Thamarassery diocese in northern Kerala urged churches to stop giving Communion on the tongue, to postpone religious classes, and to avoid weddings and family get-togethers and unnecessary travel until the virus spread was contained.[28]

Recognition

Kerala's efforts in containing the outbreak under the leadership of the Health Minister K. K. Shailaja and the Health Secretary Rajeev Sadanandan[15][29] and the then district collector were lauded by many, including the Kerala High Court[30] and Robert Gallo of the Institute of Human Virology, Baltimore.[31]

Lini Puthussery staff nurse died due to first Nipah virus outbreak. She was in the team that treated the first victim of the Nipah virus in Kozhikode

Kerala Government gave early increments to 61 people to reward them for their efforts in tackling this outbreak: 4 assistant professors, 19 staff nurses, 7 nursing assistants, 17 cleaning staff, 4 hospital attenders, 2 health inspectors, 4 security staff, 1 plumber, and 3 lab technicians. Twelve junior residents and two senior residents were also awarded gold medals of one sovereign each.

Lini Puthussery, a 28 year old nurse at the Perambra Taluk hospital who fell victim to Nipah was hailed on social media and by doctors as a hero for her sacrifice.[32] A note she had written addressed to her husband Sajish was widely circulated on social media.[33] Kerala Government Hospital Development Society (KGHDS) employees union instituted an award in Puthussery's name to an outstanding person in the sector.[34] The "Best Nurse in Public Service Award" was instituted in memory of Puthussery.[35] Jim Campbell, the Director of the Health Workforce of World Health Organisation also paid tribute, tweeting "Remember them, lest we forget: Razan al-Najjar (Gaza); Lini Puthusserry (India), Salome Karwah (Liberia)".[36]

Following the outbreak, the government modernized its only virology lab in Alappuzha and decided to establish more virology institutes in the state.

In popular culture

Virus, a 2019 Indian Malayalam medical thriller film co-produced and directed by Aashiq Abu, released on 7 June 2019 was based on 2018 Kerala Nipah virus outbreak.[37]

References

  1. ↑ "Deadly Nipah virus claims lives in India". https://www.aljazeera.com/news/2018/05/deadly-nipah-virus-claims-lives-india-180528062759101.html. 
  2. ↑ "Nipah virus outbreak: Death toll rises to 14 in Kerala, two more cases identified". The Hindustan Times. 27 May 2018. https://www.hindustantimes.com/india-news/nipah-virus-outbreak-death-toll-rises-to-14-in-kerala-two-more-cases-identified/story-f4QenFXeOtJnWhw7NrVawJ.html. 
  3. ↑ "Department of Health, Government of Kerala" (in en). https://www.facebook.com/KeralaHealth/posts/2532638213628329. 
  4. ↑ "After the outbreak" (in en). Frontline. https://www.frontline.in/the-nation/public-health/article24200872.ece. 
  5. ↑ 5.0 5.1 "Nipah virus contained, last two positive cases have recovered: Kerala Health Min". The News Minute. 2018-06-11. https://www.thenewsminute.com/article/nipah-virus-contained-last-two-positive-cases-have-recovered-kerala-health-min-82809. 
  6. ↑ "South-East Asia : Outbreaks and emergencies". https://www.who.int/southeastasia/outbreaks-and-emergencies/health-emergency-information-risk-assessment/surveillance-and-risk-assessment/nipah-virus-outbreak-in-kerala. 
  7. ↑ 7.0 7.1 "Tracking Nipah outbreak: Sabith, Patient No. 1, infected all but one" (in en-IN). 2018-07-15. https://indianexpress.com/article/india/tracking-nipah-outbreak-sabith-patient-no-1-infected-all-but-one-5259668/. 
  8. ↑ "Have scientists hit upon a magical cure for Nipah?" (in en). https://english.manoramaonline.com/news/kerala/2019/06/04/drug-remdesivir-cure-for-nipah.html. 
  9. ↑ "Kerala Health Department: These doctors were the first to figure out this infection was different". The New Indian Express. http://www.newindianexpress.com/states/kerala/2018/may/25/kerala-health-department-these-doctors-were-the-first-to-figure-out-this-infection-was-different-1819115.html. 
  10. ↑ "Kerala govt confirms 10 deaths due to Nipah virus, 2 others critical". Hindustan Times. 22 May 2018. https://www.hindustantimes.com/india-news/kerala-govt-confirms-10-deaths-due-to-nipah-virus-2-others-critical/story-RGUBQd6IgrSu0D164v8H1L.html. 
  11. ↑ "Kerala Nurse Died After Treating Nipah Patient, Left Heartbreaking Note". NDTV. 22 May 2018. https://www.ndtv.com/kerala-news/nurse-lini-who-treated-kerala-nipah-victim-left-heartbreaking-note-for-husband-1855625. 
  12. ↑ "Nipah virus: Two suspected cases reported in Karnataka - Times of India". https://timesofindia.indiatimes.com/city/mangaluru/nipah-virus-2-suspected-cases-reported-in-karnataka/articleshow/64274959.cms. 
  13. ↑ "Nipah virus: Kerala districts wear deserted look as 2,000 kept under observation; businesses strained, NRIs stranded - Firstpost". https://www.firstpost.com/india/nipah-virus-kerala-districts-wear-deserted-look-as-2000-kept-under-observation-businesses-strained-nris-stranded-4493629.html. 
  14. ↑ "Nipah drug from Australia reaches Kerala, say reports". OnManorama. https://english.manoramaonline.com/news/kerala/2018/05/25/nipah-drug-from-australia-reaches-kerala-say-reports.html. 
  15. ↑ 15.0 15.1 "Silently, additional chief secretary Rajeev Sadanandan gained the ammo to take on Nipah". The New Indian Express. http://www.newindianexpress.com/states/kerala/2018/jun/10/silently-additional-chief-secretary-rajeev-sadanandan-gained-the-ammo-to-take-on-nipah-1826033.html. 
  16. ↑ "പരിശോധനാ ഫലം ലഭിച്ചു; യുവാവിന് നിപ തന്നെ". Mathrubhumi. June 4, 2019. https://www.mathrubhumi.com/health/specials/nipah-virus/nipah-virus-confirmed-health-minister-verify-1.3846610. 
  17. ↑ "Ernakulam district declared Nipah virus free, says Kerala health minister". Press Trust of India. India Today. July 23, 2019. https://www.indiatoday.in/health/story/ernakulam-district-declared-nipah-virus-free-says-kerala-health-minister-1572681-2019-07-23. 
  18. ↑ "Nipah virus - India". 31 May 2018. https://www.who.int/csr/don/31-may-2018-nipah-virus-india/en/. 
  19. ↑ Sharma, Neetu Chandra (2018-05-22). "Third outbreak of Nipah Virus in India since 2001. What are the reasons?". Mint. https://www.livemint.com/Science/NoQYN3C3YhDUFyjK8nfrjI/Third-outbreak-of-Nipah-Virus-in-India-since-2001-What-are.html. 
  20. ↑ "12yr-old dies of Nipah in Kerala; 17 primary contacts placed under observation". The Indian Express. 2021-09-05. https://indianexpress.com/article/india/suspected-case-of-nipah-virus-in-keralas-kozhikode-7489260/. 
  21. ↑ "Nipah virus scare: Health department issues alert - Times of India ►". https://timesofindia.indiatimes.com/city/kozhikode/10-deaths-in-kerala-due-to-nipah-virus-symptoms/articleshow/64251098.cms. 
  22. ↑ "Origin of Nipah virus yet to be traced". The Hindu. 2018-06-02. http://www.thehindu.com/news/national/kerala/origin-of-nipah-virus-yet-to-be-traced/article24068976.ece. 
  23. ↑ "Fruit bats were the source of deadly Nipah Virus in Kerala: Union Health Minister". The News Minute. 2018-07-03. https://www.thenewsminute.com/article/fruit-bats-were-source-deadly-nipah-virus-kerala-union-health-minister-84088. 
  24. ↑ "Nipah: Travellers asked to avoid 4 Kerala districts". The Economic Times. 2018-05-23. https://economictimes.indiatimes.com/news/politics-and-nation/nipah-travellers-asked-to-avoid-4-kerala-districts/articleshow/64287931.cms. 
  25. ↑ Zain, Asma Ali. "Nipah virus: UAE issues Kerala travel warning". https://www.khaleejtimes.com/news/uae-health/uae-ministry-issues-travel-warning-for-nipah-virus-outbreak--. 
  26. ↑ "Pinarayi inaugurates first Institute of Advanced Virology" (in en). https://english.mathrubhumi.com/news/kerala/pinarayi-inaugurates-first-institute-of-advanced-virology--1.3557924. 
  27. ↑ Ghafur, Abdul; Kumar, A. S. Anoop; Devadasan, N.; Meena, Amit; Jose, U. V.; Zachariah, Arun; Mohandas, A. C.; Indu, P. S. et al. (2019). "Outbreak Investigation of Nipah Virus Disease in Kerala, India, 2018" (in en). The Journal of Infectious Diseases 219 (12): 1867–1878. doi:10.1093/infdis/jiy612. PMID 30364984. 
  28. ↑ Joseph, Mithosh (2018-06-01). "Holy Communion to be served on hand" (in en-IN). The Hindu. ISSN 0971-751X. https://www.thehindu.com/news/national/kerala/holy-communion-to-be-served-on-hand/article24061311.ece. 
  29. ↑ "Cooperation is key: Three Kerala govt officials on what they learnt from tackling Nipah". The News Minute. 2018-06-13. https://www.thenewsminute.com/article/cooperation-key-three-kerala-govt-officials-what-they-learnt-tackling-nipah-82995. 
  30. ↑ "Nipah outbreak in Kerala: HC commends government's efforts". The Times of India. https://timesofindia.indiatimes.com/city/kochi/nipah-outbreak-in-kerala-hc-commends-governments-efforts/articleshow/64577125.cms. 
  31. ↑ "Institute of Human Virology in Baltimore commends Kerala govt for containing Nipah". The News Minute. 2018-07-07. https://www.thenewsminute.com/article/institute-human-virology-baltimore-commends-kerala-govt-containing-nipah-84362. 
  32. ↑ "Lini Puthussery died of the Nipah virus on May 21st". The Economist. 2018-06-02. ISSN 0013-0613. https://www.economist.com/obituary/2018/06/02/lini-puthussery-died-of-the-nipah-virus-on-may-21st. 
  33. ↑ "'Hero' nurse who died battling Nipah" (in en-GB). 2018-05-22. https://www.bbc.com/news/world-asia-india-44207740. 
  34. ↑ "Lini Puthussery award Tuesday" (in en). 2019-05-19. https://www.deccanchronicle.com/nation/current-affairs/190519/lini-puthussery-award-tuesday.html. 
  35. ↑ "lini puthussery: Award instituted in Lini's memory | Thiruvananthapuram News" (in en). 28 June 2018. https://timesofindia.indiatimes.com/city/thiruvananthapuram/award-instituted-in-linis-memory/articleshow/64773163.cms. 
  36. ↑ "WHO director pays homage to Kerala’s ‘hero’ nurse who died battling Nipah virus" (in en-IN). 2018-06-05. https://indianexpress.com/article/india/lini-puthussery-who-director-pays-homage-to-kerala-hero-nurse-who-died-battling-nipah-virus-5203862/. 
  37. ↑ "Malayalam movie 'Virus' based on 2018 Nipah outbreak to release this Friday". The News Minute. 2019-06-05. https://www.thenewsminute.com/article/malayalam-movie-virus-based-2018-nipah-outbreak-release-friday-103069. 

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