How Kerala said “bye bye” to the Nipah virus

When Kerala experienced an outbreak of the Nipah virus in May, many panicked. The outbreak arrested global headlines. Some feared an epidemic on the scale of the Ebola virus. However, public health officials responded swiftly. The affected Kozhikode and Malappuram districts in Kerala have since been declared Nipah-free.

“The recent Nipah virus outbreak in India is very significant,” Dr Amesh Adalja, Senior Scholar at the Johns Hopkins University Center for Health Security, told Health Issues India. “Nipah is a virus that has many characteristics of a pandemic pathogen and it is very important to swiftly respond to outbreaks and understand the epidemiology of each of them.”

The Nipah virus tragically claimed seventeen lives. It caused a total of nineteen infections across the Kozhikode and Malappuram districts before the state health department contained it. The success of those efforts – and the speed with the success was realised – is undoubtedly good news.

“An infection that spreads from bats to humans”

The Nipah virus is zoonotic. This means it is hosted in animals but can be transferred to humans. Fruit bats caused the outbreak in Kerala, according to the Indian Council of Medical Research (ICMR).

The Nipah virus has a significant capacity for human-to-human transmission. “Though largely an infection that spreads from bats to humans,” says Dr Adalja, “there have been outbreaks in which human-to-human transmission of this deadly virus have occurred.”

More than 600 such cases were reported between 1998 and 2015, according to the World Health Organization (WHO). Fears of human-to-human transmission sparked alarm about the potential for the virus to spread, not only within India but further afield. “If the virus were to spread outside India,” The New York Times noted, “it would likely appear first in Dubai, where many Indians work.”

“Vigilance…averted an outbreak on a larger scale”

This, fortunately, did not occur. The is despite the Nipah virus being a difficult condition to diagnose, as many of its symptoms mirror those of other conditions. For example, the virus can induce flu-like symptoms such as fever, migraines and vomiting. However, the vigilance of doctors and state health officials overcame this challenge. In the process, they averted an outbreak on a larger scale.

Those displaying flu-like symptoms were encouraged to report to the Kozhikode Medical College Hospital (KMCH) for testing and treatment. A helpline was also set up so concerned citizens could report their citizens. State health departments and private hospitals undertook coordinated efforts to isolate suspected cases and those who had been in contact with infected patients. To this end, they outfitted ambulances and hospitals with quarantine units.

By mid-June, the virus had been “stalled” according to Ashwini Choubey, Union Minister of State for Health and Family Welfare. “Nipah is no epidemic,” Choubey said. “There is nothing to be scared of…the virus has been contained.”

“Kozhikode was in the grip of fear”

In early July, the state government declared the Kozhikode and Malappuram districts free of the virus.

“For the past two months, Kozhikode was in the grip of fear because of the rare Nipah virus infection,” said K. K. Shailaja, State Minister of Health and Social Welfare. “The Health Department could contain this highly infectious disease through systematic work.”

The state government has lifted the high alert it issued in mid-May in response to the outbreak. Meanwhile, precautionary measures, such as the closure of schools, were also lifted.

Preventive measures

The success of the state health department in dealing with this outbreak will not – and should not – engender complacency in future. The state government is readying itself to counter any potential future outbreaks. A research project is reportedly underway using a monoclonal antibody. This is an antibody made by identical immune cells that are all clones of a unique parent cell. It is believed it can help treat Nipah patients.

At the start of the outbreak, the antibody was flown into India from Australia. Researchers are investigating whether the antibody can be used to neutralise the virus in humans.

The importance of preventive and protective measures against future outbreaks of the disease cannot be understated. Of particular significance is understanding the human routes of transmission.

“Determining when, why, and how human-to-human transmission occurs is a key question,” according to Dr Adalja. “The development of a Nipah vaccine is also a major international priority and work is underway,” he adds. “Hopefully, in the future, Nipah will no longer be the threat that it currently is.”

“Bye bye” to the Nipah virus

The seeming defeat of the virus in Kerala is being celebrated. Perhaps the most prominent example of this is a music video. The video, titled “Bye Bye Nipah”, stars a cast including children and healthcare professionals. Many are depicted dancing, going about their daily lives and carrying signs saying “No Nipah” or “Bye Nipah.”

“The song was an effort to reclaim and celebrate our public spaces after the threat of the epidemic almost shut the city down in fear,” lyricist A Shaji Kumar was quoted as saying by NPR. Kumar also saw the video as an opportunity “to honour the effort and sacrifice of our healthcare professionals as well.”

The latter point strikes a poignant note. One of the victims of the outbreak was Lini Puthussery. A 28-year-old nurse, Puthussery contracted the virus after treating a family of three sufferers. When she began to display symptoms, she admitted herself to hospital. She succumbed to the virus the next day, survived by her husband and two children. A handwritten note she left for her husband went viral on social media. It read

“Sajeeshetta, am almost on the way. I don’t think I can meet you again. Sorry. Please look after our little ones and take them to Gulf. They shouldn’t be alone like our father. With lots of love and kisses”

The State Health Department posthumously honoured Puthussery at an event on July 1st. The event recognised the contributions of a number of the state’s health workers in fighting the Nipah virus. Other honourees included numerous doctors and district collectors in the affected areas. Their efforts were instrumental in containing the virus.

The outbreak began amidst panic. It has ended on a note of triumph tinged with the tragedy of lives lost. The achievement of Kerala’s state health department has rightly been congratulated. As preventive measures are undertaken, the hope is that any future outbreak of the Nipah virus – in Kerala or elsewhere – is contained as swiftly.