Kerala’s containment of the highly-infectious Nipah virus disease in the Ernakulum district in June shows that in states where public health service machinery works, highly-infectious diseases can be rapidly stopped from spreading.
He Kerala public health machinery delivered at every level. Patient zero’s symptoms were correctly identified, the man was tested, his positive results were shared with public health experts and the public on June 4, and he was treated in an isolation ward with the hospital staff following the recommended Hazmat and treatment protocol. The man has since then recovered and gone home.
Established disease protocols including specific case definition, contact tracing, treatment and clinical management were closely followed. The state tracked all the 50 people who had come in close contact with patient zero and tested, they were found negative for Nipah. Another 330 people they had been in contact with were also tracked for symptoms, which none of them had.
As a result, the highly-infectious virus, which spreads through contact with infected bat droppings, saliva and body fluids, through contaminated food, and directly between people, was contained within two weeks.
In Kerala, the causative link is clearly established. Infected fruit bats of the Pteropus family caused the one case of Nipah virus disease in the Ernakulum district of Kerala on June 4, said Union Health Minister Harshvardhan told the Lok Sabha on Friday. Twelve (33%) of the 36 Pteropus species bats tested for Nipahwere found to be positive for anti-Nipah bat IgG antibodies, the health minister said.
Fruit bats are reservoirs for the Nipah virus and had also led to the 2018 Nipah outbreak in Kerala. Of the 52 Pteropus giganteus bats tested in Kerala following last year’s outbreak that led to 17 deaths, 10 fruit bat samples (19%) were positive for Nipah virus antibodies, according National Institute of Virology (NIV), Pune. Human-to-human spread of the Nipah infection was first recorded in Siliguri in West Bengal in 2001, and in Kerala in 2018.
Cut to Muzaffarnagar, where acute encephalitis syndrome (AES) has led to 139 deaths over the past few weeks. The state, hoever, is nowhere close to identifying the cause. Past studies have linked deaths of acutely malnourished children from hypoglycaemia and encephalitis syndrome to their inadvertently eating toxic unripe litchi in the region and to scrub typhus infection in Gorakhpur in eastern Uttar Pradesh. But instead working on establishing an infallible link, Bihar politicians are in denial, calling it a conspiracy to “defame” Muzaffarpur litchis.
The treatment for Nipah and AES is the same. There is no preventive vaccine for humans or animals and the primary treatment is clinical management of the symptoms, yet Kerala contained Nipah virus disease that has a far higher fatality than AES. The case fatality (percentage of patients who die from the disease) of Nipah is 40% to 75%, according to World Health Organization, compared to around 5.5% fatality rate for AES in India in 2018, according to data from the Vector-Borne Disease Control Programme, India’s nodal agency that collates data of infections across states.
AES deaths in Bihar are five times higher than the national average, with one in four sich children succumbing to the disease. , in 2018, the case fatality rate was a high 26.6%.
Apart from strengthening its primary health care services, including training village health workers to identify symptoms in the initial stages, strengthening primary health centres and community health centres with equipment and medicine to manage symptoms closer to home to avoid treatment delays, and increasing surveillance, including scanning media for verification of unusual health events in print, electronic, and social media can help identify outbreaks early.
Kerala has shown it is possible.