Nipah spreads to Tamil Nadu, experts bat for testing by private laboratories

A health worker directs suspected patients at a Nipah virus isolation centre in Kozhikode on Tuesday. Pic/PTI

Days after the Nipah virus claimed the life of a 12-year-old Kerala boy, the pathogen has infected 7 people in Coimbatore of Tamil Nadu, leaving healthcare experts concerned. There is a need to step up screening with the help of private laboratories, they stressed. Currently, samples are tested only at the National Institute of Virology (NIV) in Pune, which increases its load and delays the testing process that is similar to the RT-PCR tests for Covid.

Locals in Kerala and Coimbatore this paper spoke to claimed that house-to-house screening has come to a stall and those with symptoms, especially in rural areas, continue to prefer home remedies to visiting government facilities. Nipah virus is transmitted to human beings from infected ‘fruit-bats', through infected animals like pigs, dogs, cats, goats, horses and sheep, contaminated food/fruits, or directly between people.

Dr Subhash Hira, Professor of Global Health at the University of Washington-Seattle and an expert on infectious diseases, said, "Tracing contacts of the Nipah-infected persons and putting them under isolation for 21 days is one of the restrictive measures to contain the epidemic. They are managed with symptomatic treatment because there is no known cure." Considering the load on the NIV, he said, the health ministry should encourage private labs to conduct Nipah PCR tests in south India to detect early cases "because identifying children infected by Delta variant of Covid-19 from Nipah is definitely important".

First reported in Malaysia and Singapore in 1998, Nipah had left "17-18 lives in Kozhikode in 2018", he said. The symptoms include swelling in the brain and heart that can lead to death. A patient may experience drowsiness, disorientation, and mental confusion. In some cases, symptoms could occur months or years later. "Those who survived the disease have reported long-term side effects, among them persistent convulsions and, in some cases, changes in personality," said Dr Hira.

Dr Santosh Bansode, HOD of Emergency Medicine, Wockhardt Hospitals, Mumbai Central, said, "First, we must increase Nipah virus testing centres so that anyone having a fever can be tested for it if history is strongly suspicious. We can also request private laboratories to conduct Nipah tests at a subsidised rate similar to Covid testing," he said.

Considering that there are no curbs on inter-state travel, doctors must ask for travel history of all fever patients, he said. "Festive season is very near and since Covid is in control now, people will gather in markets and other places. We must educate people about how they should take care of themselves when they are in public places," said Dr Bansode. "As we are now taking precautions for Covid, we must take precautions for Nipah as well. Here also said hand hygiene and masks play important roles," said Dr Bansode.

Dr Fazal Nabi, Director-Paediatrics, Jaslok hospital, said Nipah is not a new virus. "We have been seeing annual outbreaks in parts of Asia especially in India and Bangladesh." He said the infection, also called ‘Barking Pig Syndrome', shows its signs after 1-2 weeks. "Common symptoms include headache, fever and respiratory symptoms [sore throat and breathlessness]. Patients can also have encephalitis with seizures and altered sensorium, leading to almost 60 per cent to 70 per cent mortality especially in patients who have neurological symptoms. Consumption of contaminated date palm juices is also a source of infection," he said.

"Finally, our message is, this is not a novel virus and infection can range from asymptomatic to severe symptoms. Precautions are primarily the same for Covid and Nipah. Fortunately, the public is well educated about the viral infection and its prevention now," Dr Nabi added.