What is the Nipah protocol in Kerala?

Health Officers in Nipah Triage of the Government Medical College in Kozhikode in 2023. | Photo Credit: The Hindu

The story so far: On September 14, a new Nipah scare broke out in Malappuram, the most populous district in Kerala, where a 24-year-old man who died at the MES Medical College Hospital, Perinthalmanna, on September 9 was diagnosed with the deadly virus. Health authorities in the State remained silent that day as they awaited the final test results from the National Institute of Virology (NIV), Pune. But they were almost certain of the final results after the State virology laboratory at the Government Medical College, Kozhikode, flagged off its tests.

What followed the direct examination?

The health department adopted the Nipah protocol by forming 16 committees as described in the Nipah standard operating plan and started identifying people who were close to the victim after he started showing symptoms 10 days ago. On September 15, the Minister of Health in Kerala, Veena George, based on the result of the NIV test, in Pune, announced that the man, who was a student in Bengaluru, died of Nipah, a deadly zoonotic virus that causes a series of serious diseases. respiratory infection in fatal encephalitis. With official confirmation, restrictions were imposed on public movement and face masks were made compulsory in public places in Malappuram district.

This is the second Nipah death in Malappuram district in less than two months. On July 21, a 14-year-old boy from Chemrassery died of Nipah at the Government Medical College Hospital, Kozhikode. Despite the alarm and restrictions imposed by the government, the focus shifted when neighboring Wayanad district witnessed Kerala’s worst landslide on July 30. Nipah cases on July 21 and September 9 were within 10 km of each other in the densely populated district. While the schoolboy is thought to have contracted the virus after eating a hog plum, it is not clear how the student from Bengaluru became infected.

What is the history of Nipah case in the State?

This was the sixth case of Nipah virus spillover in Kerala since 2018, when the State reported its first case. An estimated 22 people in Kerala have died in Nipah so far. While the first outbreak claimed 17 lives in Kozhikode and Malappuram, the second incident in Pazhur in Kozhikode killed only one person in 2021. Another outbreak in Kozhikode in August 2023 claimed two lives. The recent incidents of Nipah within two months in Malappuram have sent an ominous message that Nipah may be here to stay.

Why was there a delay in identifying the virus?

The 24-year-old suspect had returned home from Bengaluru in the last week of August. He visited several clinics after suffering from fever and difficulty walking on September 5. He was admitted to MES Medical College on September 8 with symptoms of meningitis or encephalitis, where he died on the morning of September 9. Suspicions arose from a doctor who examined a man aged 24-year-old in this private medical college led him to contact the District Medical Officer and send a sample of body fluid for testing at the Kozhikode virology lab.

How did the government respond?

The government, particularly the health department and the district administration, quickly responded by declaring five community wards in the adjoining grama panchayats of Tiruvali and Mampad as containment zones. Schools, madrasas, training and educational institutes, and anganwadis in the district have been closed. Cinema halls are also closed. Shops were only allowed to open from 10 am to 7 pm. Social gatherings were banned. Masks have been made mandatory in the region, especially for students and teachers on campuses. The health department prepared a route map of the Nipah victim, traced 267 people who came in contact with him, and put them in isolation. Many of them, especially his parents, close friends and the doctors and nurses who cared for him in the hospital, were being watched closely. Their serum was collected and tested in a virology lab. So far all the results have been negative. Around 30 classmates of the victim in Bengaluru have also been advised to self-isolate.

The government also opened a Nipah control room in Malappuram and started monitoring the development. Senior health officials led by health department director KJ Reena were camped in Malappuram. Health workers in 66 teams conducted a survey in an area three kilometers from the victim’s house in Tiruvali panchayat and reached 7,953 houses within four days. About 175 cases of influenza were reported during the study period, and were monitored closely. The health department also reached out to nearly 300 people with psychological support.

Where does Nipha come from?

Bats are considered carriers of the Nipah virus. The main means of transmission of the virus from bats to humans is through the contamination of fruit eaten by bats and then eaten by humans. The virus can also be spread through contaminated food or directly from person to person through close contact with human secretions and secretions. Healthcare workers, friends and family members of an infected person are at high risk of contracting the virus.

It is not clear where the Nipah victim, 24, contracted the virus. Experts are divided on whether the virus is only caused by bats. After the 2018 outbreak, there was a campaign to destroy bat colonies, but to no avail. A definite link between Nipah and bats is yet to be confirmed in Kerala.