India - Nipah cluster in Kozhikode, Kerala - Six confirmed cases (two fatal), several suspected cases under investigation - September 11, 2023+

[alert]

The man may have lied about his exposure history in an attempt to get treatment for his (still undiagnosed) illness. Whatever it is, this man is seriously ill, but it doesn't look like Nipah.

 

[Pathfinder]

Condition of Nipah-infected nine-year-old boy in Kozhikode improving

Other three infected persons also getting better; district administration removes nine grama panchayats in Vadakara taluk from list of containment zones

September 21, 2023 08:19 pm | Updated 09:23 pm IST - Kozhikode

THE HINDU BUREAU

The condition of the nine-year-old boy from Maruthonkara in Kozhikode district, who is undergoing medical treatment at a private hospital after being infected of the Nipah virus, is reportedly improving.

He is the son of E. Mohammedali, the first patient who died of the infection in this year’s outbreak on August 30. Sources said the boy was being given physiotherapy treatment over the past few days. He is able to breathe without the help of medical equipment. Though he had been on ventilator support initially, it was removed recently. But, he was given oxygen support. Since it will take some more time for him to test negative for the virus, the boy is still under medical isolation in the paediatric intensive care unit of the hospital.

Health Minister Veena George said in a release on Thursday that the condition of the three other infected persons, including the brother-in-law of Mohammedali, was also getting better. There are 981 persons on the contact list of the infected persons at present. All the lab test results of the 27 body fluid samples of suspected patients made available on Thursday were negative.
...

https://www.thehindu.com/news/citie...oy-in-kozhikode-improving/article67330807.ece

------------------------------------------------

Translation Google

Veena George
2h

Today is also a day of relief. No new Nipah cases have been reported. Those in isolation must remain in isolation for 21 days. Everyone should wear mask properly. At present there are 981 people in the contact list. All 27 test results received today are negative. The condition of the 9-year-old boy, who is being treated at a private hospital, has improved. The health condition of others under treatment is satisfactory.

As part of Nipah prevention, the core committee met in the morning and the review meeting in the evening. Attended the meeting online.

https://www.facebook.com/veenageorgeofficial

 

[Treyfish]

Nipah Virus: There is fear in Shire, but there is no infrastructure to identify Nipah virus in West Bengal!

West Bengal: Meanwhile, the Indian Council of Medical Research (Indian Council of Medical Research) informed earlier, the death rate of Nipah virus infection is much higher than the death rate of Covid!

By: ABP Ananda | Updated at : 22 Sep 2023 06:30 AM (IST)
Edited By: Anjan Chakraborty

Jhelam Karanjai and Aritrik Bhattacharya, Kolkata: After Dengue-Malaria, Nipah Virus is looming in Bengal. Migrant workers returning to Kerala are admitted to Beleghata ID Hospital with suspicion of Nipah virus. Samples sent to National Institute of Virology, Pune. But it will take 72 hours to get the report. In the midst of this, sensational information came forward, there is no infrastructure to identify the Nipah virus in West Bengal!
Dengue is growing in power. The death toll is increasing. It is at this time that the fear of Nipah virus has increased the anxiety of Bengal. Concerns have increased manifold, after knowing that there is no infrastructure to detect Nipah virus in West Bengal! This has been reported from Beleghata ID Hospital authorities. A migrant worker returning from Kerala is being treated at the hospital, suspected of contracting Nipah virus.
After 4 days, the sample was sent to National Institute of Virology, Pune. But, experts say, after the sample reaches the agency in Pune, it will take at least 72 hours to know whether the person is infected with Nipah virus or not.
According to Beleghata ID sources, the 26-year-old youth, admitted as a suspect of Nipah, is a resident of Mangalkot in East Burdwan. Worked as a migrant laborer in Kerala. Many of those with whom he lived were reported to be infected with the Nipah virus. 5 years ago Nipah outbreak in Kerala. Outbreaks are also seen in 2019 and 2021. At least 23 people infected with Nipah virus were found in 2018. 17 people died....:tiphat:https://bengali.abplive.com/distric...-beleghata-id-hospital-confirms-1010923​​​​​​
​

 

[Shiloh]

Source: https://www.dtnext.in/news/national...cted-at-jipmer-hospital-in-pondicherry-737846

Nipah scare: Case suspected at JIPMER hospital in Pondicherry T
he patient had a history of travel to Nipah affected areas in Kerala and the symptoms of Encephalitis have been reported to be indicative of Nipah.
DTNEXT Bureau|22 Sept 2023 1:00 PM ( Updated:22 Sept 2023 1:00 PM )

CHENNAI: A suspected case of Nipah virus was reported at JIPMER hospital in Pondicherry on Friday. A 45-year-old man from Chidambaram had visited a local hospital with complaints of fever and other related symptoms of body pain. The hospital authorities had referred him to JIPMER after he reported symptoms of Acute Encephalitis Syndrome (AES). The patient had a history of travel to Nipah affected areas in Kerala and the symptoms of Encephalitis have been reported to be indicative of Nipah. The officials from the health department said that the samples will be sent to the National Institute of Virology (NIV) to test for the presence of virus to confirm if the case is positive for Nipah...

 

[Pathfinder]

Translation Google​

NIPAH: NO NEW CASES TODAY; 66 PEOPLE WHO COMPLETED ISOLATION WERE REMOVED FROM THE CONTACT LIST

September 23, 2023

Trunat will set up a testing system, including in public health labs

Steps will be taken to set up Trunat testing facility at state and district level labs including public health labs. ICMR According to the criteria, the S.O.P. Will be prepared. All District Medical Officers have been directed to submit details of labs having facilities to conduct RTPCR and Trunat tests in their respective districts. SOP Training and labs will be set up on a priority basis as they become available. A lab was set up at the Kozhikode Medical College in one day to conduct other tests for Nipah positive patients.

No new Nipah cases reported today. The results of 7 samples received this morning are also negative. So far 365 samples have been sent for testing. 66 people who have completed isolation have been removed from the contact list today. At present there are 915 people in the contact list. The health condition of the 9-year-old under treatment remains satisfactory. The health condition of others under treatment is satisfactory. Those who completed 21 days of observation in other districts in the contact list of the index case were excluded from the list.

As part of Nipah prevention, the core committee met in the morning and the review meeting in the evening.


https://minister-health.kerala.gov.in/nipha/

 

[Shiloh]

Source: https://www.dtnext.in/news/tamilnad...ipmer-tests-negative-for-the-infection-737998

Suspected case of Nipah at JIPMER tests negative for the infection A 45-year-old man from Chidambaram was working in Kerala, near Kozhikode and had come back to his home town after he fell ill due to fever and cough.
DTNEXT Bureau|23 Sept 2023 10:03 AM

CHENNAI: The samples of the suspected case of Nipah reported at JIPMER hospital in Pondicherry has turned out to be negative on Saturday. A 45-year-old man from Chidambaram was working in Kerala, near Kozhikode and had come back to his home town after he fell ill due to fever and cough...

 

[Pathfinder]

Last Updated: Sep 24, 2023 8:58AM

Nipah Virus : District authorities in Kozhikode to resume regular classes in all educational institutions from Sep 24 except in containment zones

The district authorities in Kozhikode have decided to resume regular classes in all educational institutions from tomorrow, except in containment zones, where classes in online mode will continue. A decision in this regard was taken by District Collector A Geetha, taking into account the reduction of Nipah positive cases in the district. Students, teachers and other officials reaching educational institutions have been asked to wear masks and make use of sanitisers.

Meanwhile, State Health Minister Veena George said community surveillance will continue as part of the steps taken to control Nipah infection in the district. She said programmes based on "One Health" concept will be launched. Veena George expressed satisfaction that no positive cases were reported in the district for the past eight days.

The Minister said as part of zero surveillance, the antibodies of those who were in close proximity with Nipah positive patients will be tested. She said the government is also examining the feasibility of producing monoclonal antibodies locally.


https://newsonair.gov.in/News?title...-Sep-24-except-in-containment-zones&id=468268

 

[Pathfinder]

All 4 Nipah positive patients in Kozhikode have recovered

Isolation for 14 days

Health Minister Veena George informed that four people, including a nine-year-old child who tested positive for Nipah in Kozhikode district, were discharged from the hospitals after they tested negative twice within five days. As per NIPA protocol, three samples namely throat swab, blood and urine were tested. All these three samples were found to be negative. Following this, all four people were discharged on Friday.

Kozhikode Govt. One in Medical College, one in Iqra Hospital and two including baby in Mims Hospital. The health worker who was in Iqra was staying in the hostel earlier. He will continue to be isolated in a special system. Others returned home.

All four are disease free. But as per Nipah protocol, they have to stay in isolation for the next 14 days. Being in isolation is so that they can return to their normal routines in full health and prevent them from getting infected from others. Before letting them go home, health workers led by medical officers went to their homes and checked things like general hygiene. The minister said that he spoke to the patients through video call.It was an achievement that we were able to detect the first case of Nipah infection. The disease was quickly recognized as Nipah. Due to this, it was possible to prevent a second wave from spreading the disease from the first case to others. The minister said that Nipah was brought under control through the collective efforts of all.There are currently 568 people in isolation on the contact list. Their isolation will end on October 5. 81 people on the contact list were released from isolation on Friday. The operations of the control room will continue till October 26. There will be surveillance to see if anyone gets infected in any way.

It is important that not a single life was lost after the disease was diagnosed. Here the death rate is 33 percent. The mortality rate of common Nipah is above 70 percent. Maybe because they were diagnosed with Nipah and given anti-viral drugs, they returned to normal. Community surveillance of various departments will continue in Kozhikode district. As a part of Ek Gedeshwar, a meeting will be held every fortnight under the leadership of the district collector who is the chairperson of the district. This can be studied, including when animals die abnormally. A district specific standard operating procedure has been prepared as part of this.

NIV Pune's mobile lab is working here and they are imparting training. They will remain here till October 7. The minister said that the True Nat verification system will continue.


https://keralanews.gov.in/23687/Nipah-positive-patients-in-Kozhikode-have-recovered.html

 

[Pathfinder]

Nipah Virus Infection - India

3 October 2023

Situation at a glance

From the 12 to 15 September 2023, the Ministry of Health and Family Welfare, Government of India, reported six laboratory-confirmed Nipah virus cases, including two deaths, in Kozhikode district, Kerala. Aside from the first case, whose source of infection is unknown, the other cases were family and hospital contacts of the first case. As of 27 September 2023,1288 contacts of the confirmed cases were traced, including high-risk contacts and healthcare workers, who are under quarantine and monitoring for 21 days. Since 12 September, 387 samples have been tested, of which six cases were positive for Nipah virus infection, and all remaining samples tested negative. Since 15 September, no new cases have been detected. This is the sixth outbreak of Nipah virus in India since 2001.

Nipah virus infection, a zoonotic illness, is spread to humans through contact with infected animals such as bats and pigs. Additionally, direct contact with an infected individual can also lead to transmission, although this route is less common. Those affected by Nipah virus infection may experience severe symptoms, including acute respiratory infection and fatal encephalitis. The only way to reduce or prevent infection in people is by raising awareness about the risk factors and preventive measures to protect themselves. Case management should focus on providing patients with supportive care measures and intensive support for severe respiratory and neurologic complications.

State and national authorities activated a multisectoral coordination and response mechanism to contain the spread of the outbreak including enhanced surveillance and contact tracing, laboratory testing of suspected cases and high-risk contacts, hospital preparedness for case management, infection prevention and control (IPC), risk communication and community engagement.

Description of the situation

Between 12 and 15 September 2023, a total of six laboratory-confirmed cases of Nipah virus infection including two deaths were reported by the State Government of Kerala. All confirmed cases were males within the age range of 9 to 45 years old and were reported within the Kozhikode district of Kerala.

The first case whose source of infection is unknown, had pneumonia and acute respiratory distress syndrome (ARDS) and was admitted at a hospital in late August 2023. He died a few days after admission. The other five confirmed cases were close contacts of the first case including two family members and contacts at the hospital where the first case was treated and died. The second death occurred in an individual who accompanied another patient to the hospital where the first case was being treated. He died after presenting with symptoms of pneumonia.

As of 27 September 2023, 1288 contacts of the confirmed cases have been traced, including high-risk contacts and healthcare workers who treated the confirmed cases and processed their samples. All identified contacts are under quarantine for a period of 21 days. As of 27 September 2023, the four cases remain clinically stable.

The Government’s response measures included declaring containment zones in nine villages in the Kozhikode district with movement restrictions, social distancing, and mandatory mask-wearing in public spaces. The government restricted major public events in Kozhikode district until 1 October 2023. Alerts were issued to neighbouring districts and states for enhanced surveillance.

According to the National Institute of Virology (NIV), Pune, the virus found in Kerala has been identified as the Indian Genotype or I-Genotype and is similar to the Nipah virus strain found in Bangladesh.

Epidemiology of the disease

Nipah virus infection is an emerging bat-borne zoonotic disease transmitted to humans through infected animals (such as bats and pigs) or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person (although this represents a less common transmission route).

Nipah virus infection in humans causes a range of clinical presentations including acute respiratory infection and fatal encephalitis. The case-fatality rates in outbreaks across Bangladesh, India, Malaysia, and Singapore typically range from 40% to 100%. As of now, there are no available effective therapies or vaccines for this disease.

The current outbreak is the third Nipah virus outbreak in Kozhikode district, Kerala, the fourth outbreak in Kerala state since 2018 and the sixth outbreak in India. Similar to the previous outbreak in 2018 in Kerala, this outbreak started with the first case and subsequent clustering of cases in family contacts and likely nosocomial transmission in hospitals. In the WHO South-East Asia Region, only Bangladesh and India have reported Nipah virus outbreaks.

Public health response


The following public health response measures were implemented by the Department of Health and Family Welfare, State Government of Kerala, with support from the Ministry of Health and Family Welfare, Government of India, and its institutions; Indian Council of Medical Research (ICMR), National Institute of Virology (NIV), Pune, and National Institute of Epidemiology, Chennai.

Coordination: Multiple central multi-disciplinary teams were mobilized by the Department of Health & Family Welfare, Department of Health Research as well as Department of Animal Husbandry to support the State and District administration in containment and mitigation measures. A total of 19 core committees were created and tasked with various response measures including surveillance, sample testing, contact tracing, patient transportation, case management, logistics and supplies, training and capacity building, risk communication and community engagement, psychosocial support and animal husbandry. A control room with a call center was activated in the district to coordinate the response activities.

Surveillance and contact tracing: As part of community-based surveillance activities, active house-to-house surveillance was carried out by the district health authorities in the containment zones declared. A total of 53,708 houses have been surveyed as of 27 September 2023. As of 27 September, 1288 contacts including high-risk contacts were identified and quarantine with follow up exercise ongoing. All high-risk contacts were tested. Containment zones were declared in nine villages in Kozhikode district with movement restrictions, social distancing and mandatory mask-wearing in public spaces. The government restricted major public events in Kozhikode district until 1 October 2023. Alerts have been issued to neighbouring districts and states for enhanced surveillance.

Laboratory testing: Laboratory testing of suspected cases as well as environmental and animal samples is being conducted at the Regional Viral Research and Diagnostic Laboratory network lab at the Government Medical College (GMC), Kozhikode; Indian Council of Medical Research (ICMR) Mobile BSL-3 lab; Field unit of NIV at Alappuzha as well as NIV, Pune. As of 27 September 2023, no environmental/animal samples (including bats) have tested positive for Nipah virus.

Health facility preparedness: Emergency departments have been equipped to handle any suspected cases and respond to emergencies. Isolation rooms and intensive care units (ICU) are being kept ready to treat suspected cases, where required. The State has earmarked isolation rooms, ICU beds, and ventilators to mount surge capacity when needed. Suspected and confirmed cases are being managed at designated health facilities. For patient transport, dedicated ambulances have been mobilized.

Infection prevention and control: The State Government has initiated training of healthcare workers on infection prevention and control (IPC). Adequate stocks of Personal Protective Equipment (PPEs) have been made available to health care workers and IPC practices are being strictly adhered to and audited.

Logistic management: Adequate stocks of PPEs, drugs and other requisite logistics are being provided by the State Government.

Dead body management: Arrangement has also been made for the transfer and management of dead bodies by the State Government in compliance with the standard protocol and IPC precautions.

Risk communication and community engagement: Information education and communication activities through different modalities (including regular press releases) have been initiated. Further, audio spots and video bytes by expert doctors are being issued. Infodemic management strategies are currently being implemented with strict action taken against fake news. A call center to provide psychosocial care has also been established by the State Government.

Animal Sector: Samples of bats, animal droppings, and half-eaten fruits were collected on 15 September from the village where the first case lived, in a 300-acre (121-hectare) forest which is home to several bat species. All samples tested negative for Nipah virus.

Public health response measures were implemented in accordance with the guidelines developed by the State Government and Government of India with support from WHO and partners during the 2018 Nipah virus outbreak in Kerala state.

WHO risk assessment


This is the sixth outbreak in India since 2001 when the first outbreak was reported in Siliguri town, West Bengal (66 cases, CFR: 68%). Subsequently, five outbreaks have been reported- Nadia district, West Bengal (5 cases; CFR: 100%), Kozhikode and Malappuram, Kerala in 2018 (23 cases including confirmed and probable; CFR: 91%), Ernakulum, Kerala in 2019 (a single case who survived) and Kozhikode, Kerala in 2021 (one case, CFR: 100%).

The following factors may contribute to the risk associated with this outbreak:

• The exposure of the first case in this outbreak remains unknown;
• The presence of a bat population which has been reported to harbor Nipah virus and therefore acts as a potential source of infection;
• High reported case fatality rate (33.3%) and high number of contacts; and
• The absence of Nipah virus-specific therapeutics and vaccines.

At the same time, the current outbreak is not entirely unexpected and is the third outbreak in Kozhikode district and fourth in the state of Kerala. Current cases are clustered and epidemiologically linked to the first case, and cases are localized to Kozhikode district. Public health teams and health care workers in Kozhikode have prior experience in managing outbreaks of Nipah virus infection. The State Government has rapidly established response measures to contain the spread of the outbreak and through enhanced surveillance and contact tracing measures, 1288 contacts have been identified and are under monitoring. High-risk contacts are being tested.

WHO advice


In the absence of a vaccine or licensed treatment available for Nipah virus, the only way to reduce or prevent infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to Nipah virus infection. Case management should focus on the delivery of supportive care measures to patients. Intensive supportive care is recommended to treat severe respiratory and neurologic complications.

Public health educational messages should focus on:

Reducing the risk of bat-to-human transmission

Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of bat bites should be discarded. Areas where bats are known to roost should be avoided. The risk of international transmission via fruit or fruit products (such as raw date palm juice) contaminated with urine or saliva from infected fruit bats can be prevented by washing them thoroughly and peeling them before consumption.

Reducing the risk of animal-to-human transmission

Natural infection in domestic animals has been described in farming pigs, horses, and domestic and feral cats. Gloves and other protective clothing should be worn while handling sick animals or their tissues and during slaughtering and culling procedures. As much as possible, people should avoid being in contact with infected pigs. In endemic areas, when establishing new pig farms, consideration should be given to the presence of fruit bats in the area and in general, pig feed and pig sheds should be protected against bats when feasible. Samples taken from animals with suspected Nipah virus infection should be handled by trained staff working in suitably equipped laboratories.

Reducing the risk of human-to-human transmission

Close unprotected physical contact with Nipah virus infected people should be avoided. Regular hand washing should be carried out after caring for or visiting sick people. Health care workers caring for patients with suspected or confirmed infection, or those handling their specimens, including trained staff working in suitably equipped laboratories, should always implement infection prevention and control standard precautions as well as contact and droplet precautions when providing care or working in the rooms of patients with suspected or confirmed Nipah virus and when handling/managing linens or waste from patients with Nipah virus. Case management should focus on the delivery of supportive care measures to patients. Intensive supportive care is recommended to treat severe respiratory and neurologic complications. Safe burial practices are required for all confirmed and suspected Nipah virus infected cases.

Infection prevention and control

In health care settings, patients who are suspected of Nipah virus should be isolated in well-ventilated single rooms with dedicated patient equipment and toileting. Patients with suspected Nipah virus should not be placed in cohort rooms. Health care workers interacting with patients with Nipah virus should use contact and droplet precautions when caring for patients with Nipah virus. Contact, droplet, and airborne precautions should be used, including placement of a patient in an airborne isolation room when aerosol-generating medical procedures are performed. If airborne isolation rooms are not available, a well-ventilated single room with windows open if using natural ventilation with doors to corridors closed. Cleaning and disinfection of all surfaces in patient rooms housing suspected or confirmed patients with Nipah virus should occur at least once daily. After cleaning with soap and water, a 0.5% sodium hypochlorite solution disinfectant should be applied to surfaces, remaining untouched for 5 minutes contact time. Immediate cleaning and disinfection, as well as high touch surface cleaning, should be performed whenever a spill of blood or body fluid occurs. Health facilities should be equipped with enhanced water, sanitation and hygiene services to meet the needs of staff, patients and caregivers. Safe waste management practices should be adhered to by the health care facilities.

WHO infection prevention and control advice when caring for patients with Nipah virus infection is currently under review and is pending update.

WHO advises against the application of any travel or trade restrictions on India based on the current information available on this event.

...​

https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON490