Kozhikode: Three years after it claimed seventeen lives in Kerala, the deadly Nipah virus infection has resurfaced even as the state is dealing with the COVID pandemic.
This time, the Nipah virus has claimed the life of a 12-year-old boy from Kozhikode.
The Chathamangalam-Pazhoor native had been suffering from fever and other symptoms for the past four days. He died in the wee hours of Sunday.
"The child's condition was critical yesterday [Saturday] itself with the blood pressure levels going down. The boy died at 5 am today [Sunday]," Health Minister Veena George said.
"The results of tests done at the National Institute of Virology (NIV) in Pune on all three samples – Plasma, CSF (Cerebrospinal fluid) and Serum – came positive for Nipah virus late Saturday night," the minister said.
The minister also added that the boy was COVID-19 negative.
The boy's burial was done at the Kannamparambu Juma Masjid in Kozhikode early Sunday.
Primary contacts traced
The close contacts of the deceased boy have been identified and informed.
Of them, 20 fall under the high-risk category.
Two among them - both healthcare workers: one from the Medical College and another from a private clinic - also have symptoms.
They will be moved to the newly-formed Nipah ward at the Government Medical College Hospital in Kozhikode.
A total of 188 people are under observation. Among them, 136 are health workers - 100 from the Medical College and 36 from the private clinic from where the boy was admitted to.
"All primary contacts of the boy have been identified and measures have been taken to isolate them," George said.
According to the minister, a timeline of the infection and a route map to trace those who came in contact with the child has already been prepared.
Wards shut, alert sounded
In the wake of the boy's death and the confirmation of the Nipah outbreak, local authorities have employed a series of measures to check any further spread of the dreaded virus in Kozhikode and surrounding areas.
The authorities have declared a health alert in the district and cordoned off about three kilometres around the house of the deceased child.
The health officials have closed Ward No 9 of the Chathamangalam gram panchayat.
Partial restrictions have been imposed in Wards 8, 10 and 12.
The hospital where the boy was being treated since September 1 is on alert and the situation there is being closely monitored, sources said.
The staff of the local hospital in Omaserry near Mavoor, where the child was first taken for consultation after he developed severe fever late in August, has also been alerted.
Pazhoor (ward 9) of Chathamangalam panchayat, where the boy's house is located, has been fully closed and nearby wards of Nayarkuzhy, Koolimad, Puthiyadam wards were partially closed, the sources said, adding that police have been deployed to restrict vehicle and people's movement in or out from these places.
Locals said police personnel reached there around 4 am and closed all pocket roads leading to the child's house.
They also said that the roads there are deserted now and police have informed them that the main road in Pulpara and Koolimadu would also be closed after some time.
The Mukkam-Koolimadu-Chendamangalam road has been closed in the 1.5 km radius of Pazhoor.
The health authorities have alerted the people in the area to immediately report any instances of fever, vomiting and other health disorders.
An alert has also been sounded in the neighbouring districts of Kannur and Malappuram.
Dedicated cells formed, Centres rushes team
Sixteen committees have been formed for preventive activities.
A team from the National Institute of Virology, Pune, will arrive at the Kozhikode Medical College Hospital where they will set up a lab to conduct Point-of-Care testing.
Those found positive in the final test will be subjected to a confirmatory test.
The NIV has said that they will give the results within 12 hours.
The Centre has also rushed a team from the National Centre for Disease Control to Kerala.
The team, expected to reach on Sunday, will provide technical support to the state, the Union Health Ministry said.
The Ministry has also advised few immediate public health measures including active case search in the boy's family, other nearby families, in the village and areas with similar topography, especially in Malappuram.
The measures also include active contact tracing for any contacts in the past 12 days, strict quarantine of the contacts and isolation of any suspects, and collection and transportation of samples for lab testing.
A dedicated call centre has been opened for Nipah-related assistance and enquiries.
The numbers are 0495 238 2500, 0495 238 2800.
A Nipah control has been opened at the Government Guest House in Kozhikode.
'Kerala has sufficient stock of medicines to contain outbreak'
Kerala Health Minister Veena George has informed that the state has sufficient stock of medicines to contain any Nipah virus outbreak.
More medicines will be brought to the state by the Indian Council of Medical Research (ICMR).
Addressing the media after a high-level meeting on Sunday, the minister assured that the state has taken precautionary measures to contain the virus spread and treat any potential patients.
Since the monoclonal antibody stock the state had received in 2018 was made in 2015, the minister had made another request for fresh monoclonal antibody from ICMR.
"They [ICMR] have promised to make it available from Australia in seven days," the minister added.
The lifespan of a monoclonal antibody is five years.
Additional manpower will be recruited for Nipah care, the health minister said.
Nipah outbreak in 2018
The first Nipah virus disease (NiV) outbreak in South India was reported in the Kozhikode district of Kerala on May 19, 2018.
The state had witnessed 17 deaths and 18 confirmed cases till June 1, 2018. The infection was traced to fruit bats in the region.
Nipah's origin
The virus was first identified in the Kampung Sungai Nipah area of Malaysia in 1998 when a brain fever epidemic broke.
The disease spreads from fruit bats to humans as well as animals.
Most of those infected people were workers at pig breeding centres.
The virus can also pass on to humans from fruits that have been touched by bats.
It could spread from infected people to others. No vaccine has been developed yet.
The NiV infection was reported later in Bangladesh in 2001 after it spread to humans who consumed date palm sap contaminated by infected fruit bats.
According to WHO, human-to-human transmission has also been documented, including in a hospital in India.
It was reported in many studies that there was a threat of a further outbreak of this dangerous disease larger on the Indian subcontinent.
Signs and symptoms, transmission
Infection with NiV is associated with encephalitis (inflammation of the brain).
The disease begins with breathing difficulty, terrible headache and fever and progresses to brain fever.
The death rate among infected people is 74.5 per cent.
NiV infection in humans has a range of clinical presentations, from asymptomatic infection to acute respiratory syndrome and fatal encephalitis, says WHO.
Transmission of NiV to humans occur after direct contact with infected bats, infected pigs, or from other NiV infected people.
