Nipah virus death reported in Kerala, India
Officials in Kerala state in southern India are reporting a fatal case of Nipah virus infection in a 14-year-old boy from Mallapuram district in Kerala.
The national Ministry of Health and Family Welfare reports the boy exhibited Acute Encephalitis Syndrome (AES) symptoms and was admitted to a healthcare facility in Perinthalmanna before being transferred to a higher health center in Kozhikode. However, the patient later succumbed to the disease.
The samples were sent to the National Institute of Virology (NIV), Pune which has confirmed a Nipah virus infection.
Health authorities have advised the following immediate public health measures to be taken by the State government:
Active case search in the family of the confirmed case, the neighborhood, and areas with similar topography.
Active contact tracing (for any contacts) during past 12 days.
Strict quarantine of the contacts of the case and isolation of any suspects.
Collection and transportation of samples for lab testing.
A multi- member joint outbreak response team from the National ‘One Health Mission’ of Union Health Ministry will be deployed to support the State in investigating the case, identifying epidemiological linkages, and providing technical assistance.
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Additionally, at the State's request, ICMR had sent monoclonal antibodies for patient management, and a mobile BSL-3 laboratory for testing additional samples from contacts has arrived in Kozhikode. The Monoclonal Antibodies had reached before the patient died but could not be used due to his poor general condition.
Kerala state has reported several outbreaks in recent years—Kozhikode and Malappuram, Kerala in 2018 (23 cases including confirmed and probable; CFR: 91%), Ernakulum, Kerala in 2019 (a single case who survived), Kozhikode, Kerala in 2021 (one case, CFR: 100%) and six cases and two deaths in Kozhikode district, Kerala last September 2023.
This is the first know case in India this year, while Bangladesh has reported four fatal cases earlier this year.
Nipah Virus Infection : A Newly Emerging Disease
Nipah virus (NiV) is an emerging and serious viral zoonotic disease that carries with it a high case fatality rate (in the ballpark of 70% or more).
NiV is an enveloped RNA virus and along with Hendra virus make up the Henipahviruses.
The natural host of the virus are fruit bats of the Pteropodidae family, Pteropus genus.
It was first recognized in a large outbreak in Kampung Sungai Nipah, Malaysia and Singapore from Sep 1998 – May 1999.
276 cases were reported, the vast majority (93%) being pig farmers or people who had contact with pigs. The disease presented as encephalitis and four out 10 people died.
It is theorized that the pigs got infected consuming partially bat-eaten fruit that ended up in a pigsty. Pigs were the intermediate host in this case; however, subsequent outbreaks had no intermediate hosts.
No new outbreaks have been reported in Malaysia since 1999.
The outbreaks since the initial one in Malaysia (Bangladesh and India) have been linked to two possible routes of transmission—consumption of raw date palm sap that had been contaminated with urine or saliva from infected fruit bats and strong evidence points to human-to-human transmission (close physical contact, especially contact with body fluids).