Eight more people have been identified in Kozhikode district in Kerala today (Monday) with Nipah fever symptoms after the outbreak claimed a 12-year-old boy the previous day. The size of the high-risk group (primary contact) has swelled to 32 while 251 more got added to the existing contact list of 188.

The high-risk persons have been admitted to the special ward at the Government Medical College Hospital. Test results of seven persons from the existing group are awaited from the National Institute of Virology (NIV), Pune, by evening. A high-level meeting of ministers is going on at Kozhikode Guest House.

Identifying source of infection

This is even as coordinated efforts led by the Animal Husbandry Department are on to zero in on the source of the virus from around the home of the victim in interior Kozhikode. Latest reports from the area said that samples were taken from a domesticated goat that had developed illness recently.

The Forest Department has been roped into the effort, which will take samples both from fruit bats and wild boars, which will be sent to the National Institute of High Security Animal Diseases in Bhopal. Yet another group of experts have taken samples of rambutan fruits from the immediate neighbourhood.

‘Point of care’ facility

Meanwhile, sources in the government said that the sample test results from NIV, Pune, awaited in the evening and ongoing investigations will help bring out the extent of the infection. An effective containment strategy will be formulated based on these for expedited implementation.

The NIV is helping set up a ‘point of care’ testing facility at the Medical College Hospital where samples can be screened initially. The suspect ones may be sent to Pune for confirmatory tests and results will be known in 12 hours. There is enough stock of medicine but the monoclonal antibody is in short supply, sources say.

Monoclonal antibody supply

The Indian Council of Medical Research, New Delhi, has assured the State Health Department that the requirement of the immunity-boosting monoclonal antibody would be sourced from Australia shortly.

A separate ward and a negative-pressure ICU are already operational at the Medical College Hospital.

Sources said that concurrent prevalence of Covid-19 and Nipah viruses have started to tell on the human resources capacity available to deal with them. At least 16 separate groups now involved Nipah sourcing and tracing has translated to a huge drawdown from the healthcare resource pool managing Covid-19.

Covid-Nipah virus dilemma

The State Health Department is probing an allegation on the apparent ‘failure’ of the Medical College Hospital in taking a swab or identifying the disease (Nipah virus was identified at a private hospital later) despite having the experience of successfully managing the earlier outbreak in 2018.

Since then, the hospital was under instruction to check on without fail any case presenting with high fever and encephalitis. In this case, the hospital had allegedly wasted 24 hours by idling the patient, exposing him to a number of healthcare workers, most of whom are now under observation.

The hospital is learnt to have argued that although aware that the patient was in a serious condition, it could do precious little since no ventilators were available. Most of them were occupied by Covid-19 patients, which brought the sharp focus on its dilemma given the active Covid case load in Kozhikode.

Condition worsens suddenly

It was initially suspected that it was a case of viral fever. But the condition of the patient had worsened suddenly after he developed encephalitis and pneumonia. It was at the insistence of the parents that the patient was allowed to be moved to a private hospital where he later succumbed.

According to Jacob T John, leading virologist and former professor at CMC Vellore, it is more or less clear that fruit bats in Kerala may be carriers of the Nipah virus as evident from repeated outbreaks. These are nocturnal mammals and are known to feast on fruits during the nights.

Fruit bats likely carrier

Humans must take care not to consume stray fruits that drop down into homestead overnight and children should be properly guided as such. Having said so, it is incumbent on the Health Department and Forests/Animal Husbandry Department to find the exact source of the outbreak, John says.

AS Anoop Kumar, Senior Consultant and Chief, Critical Care, Baby Memorial Hospital, Kozhikode, who was instrumental in identifying the first Nipah virus outbreak in 2018, said that Kerala needs to set up an effective observation/examination and treatment protocol for all types of brain encephalitis cases.