The Kerala health department has confirmed that three people from one family in the Perambra block in Kozhikode district who died over the past week had Nipah virus encephalitis, a rare but emerging infectious disease. The patients went to the government medical college and nearby hospitals with fever and cold-like symptoms that quickly advanced to encephalitis, which is inflammation of the brain, and myocarditis, which is inflammation of the heart.

“The Nipah infections were detected by Manipal Centre for Virus Research and then confirmed by the National Institute for Virology,” said Dr G Arunkumar who heads the Manipal Centre for Virus Research. “Right now it is very localised. There is no community outbreak. It is only an event. But search and testing is being conducted to check for other cases.”

The death of a nurse at the Perambra Taluk Hospital in Kozhikode district, who treated the three patients with Nipah, was suspected to be a result of her having contracted the infection.

The health department and doctors in Kozhikode emphasised that there was no need to panic even as they observed more people with fever coming to government hospitals on Monday morning.

Two of the three patients infected with Nipah were admitted to Baby Memorial Hospital. “More people have been coming in with fever to the government medical college,” said Dr Fabith Moideen, the chief of emergency medicine at the hospital and president of the Society for Emergency Medicine in Kerala.

Hospitals are implementing infection control measures to ensure that the infection does not spread. “Right now, the chances of transmission are higher within health facilities than in the community,” said Arunkumar.

Moideen met with emergency physicians in Kozhikode town to discuss a plan to contain the infection. He outlined some of the measures the hospitals are planning to implement immediately. “There should be isolation rooms so that a patient suspected with Nipah infection does not come in contact with other patients,” said Moideen. “There should be one nurse who can take care of that patient. All the items for treating the patient should be available in the same room.”

Community education to raise awareness of the dangers of Nipah infection from drinking raw date palm sap in Kagdi, Shaltha, Bangladesh in February 2014. (Photo: CDC Global/Flickr)

Preventive measures

Besides this, the health worker treating the patient should have full personal protection like goggles, mask, apron and shoe covers.

“The Nipah virus is not transmitted through air, which is good,” said Moideen. “Other viruses in this group can be airborne and that is very dangerous.”

The Nipah virus can be transmitted through contact and body fluids but is not known to be transmitted through air. “All body fluids are infectious and within one metre the infection can also be transmitted through aerosols, like during sneezing or coughing,” said Arunkumar.

Doctors advise the general public to take standard precautions like washing hands with soap and water, keeping a distance of one metre from an infected person, not sleeping in the same bed as a person who is infected or suspected to have the infection.

“Carry hand sanitiser with you wherever you go and whenever possible, wash your hands,” said Moideen. “Even doors and door handles might be infected. So people should wash their hands after going to any public place. During any infection, personal hygiene is very important so people must change and wash their clothes every day. It is important to cover your mouth with a towel or your sleeve while coughing or sneezing.”

Since the reservoir of the Nipah virus is the fruit bat, doctors also recommend that people avoid eating fallen fruit and fruit with any signs of bites.

Meanwhile, Kerala health department officials as well as those from the National Centre for Disease Control are in Kozhikode district to implement measures for containment and to track down other people who might have been infected.

There is no vaccine or cure for Nipah infections and treatment is restricted to intensive supportive care of patients till the symptoms subside.

Nipah outbreaks in the past

The World Health Organisation recognises the Nipah virus infection as a newly emerging zoonosis that causes severe disease in both animals and humans, with its natural host being the fruit bat. There is no vaccine for either humans or animals, the WHO notes. The primary treatment for human cases is intensive supportive care.

The disease has so far been seen in south and south-east Asia. The virus was first identified in a town in Malaysia called Kampung Sungai Nipah in 1998, when there was the first known outbreak of the disease. People contracted the virus from infected pigs. Bangladesh has seen repeated outbreaks of Nipah virus encephalitis since 2001. India has had two outbreaks of Nipah, both in West Bengal, bordering Bangladesh – in Siliguri in 2001, and in Nadia district in 2007. Seventy one people were infected and 50 of these people died in the two outbreaks.

In India and Bangladesh, there has been no transmission of the Nipah virus through pigs. Instead, the infection spread from fruit bats that drink sap of the date palm trees to people who drank raw date palm sap as toddy. Previous cases in Bangladesh and India show that Nipah virus encephalitis usually occurs as a cluster of infections or as outbreaks, although there have been some instances of isolated cases.

“In Bangladesh, it has been seen that the season for transmission of the infection is December to May and once the rain comes the season ends,” said Arunkumar. That is good news, he added, as the monsoon is expected soon in Kerala.