A central health ministry team, constantly reviewing the situation in the wake of deaths due to the Nipah virus in Kerala, on May 23 interacted with doctors at government and private hospitals as well as the common public there to create awareness about the disease and dispel fears.
 

A part of the team led by Dr S K Singh, Director of National Centre for Disease Control, visited Malappuram district along with the state health minister and interacted with the general public. Cinical management and treatment procedures were explained to the patients. The team also interacted with doctors of government and private hospitals. It made an effort to create awareness and allay any fears in the minds of the people about the disease, the health ministry said in a statement.

The team also devised draft guidelines, case definitions, advisory for healthcare workers, information to the general public, advisories for sample collection and transportation and a brief on the Nipah virus disease, the statement said. Another team led by Dr P Ravindran, Director (Emergency Medical Relief), visited the Government Medical College, Kozhikode and reviewed the treatment procedure, infection control practises, use and availability of personal protective equipment (PPE) and availability of drugs, particularly in the designated wards.

An action plan was also developed for the healthcare staff and simulation exercise was planned. "The team also held meetings with the District Collector, Kozhikode and discussed streamlining the reporting mechanism and strengthening inter-sectoral coordination. "It was decided to provide separate ambulances for transportation of the suspects to designated isolation facilities. The interim guidelines, case definitions, advisories to healthcare workers and information to the general public were shared," the statement said.

Advisories were issued for sample collection and transportation also. According to health ministry, there have been 11 deaths, eight in Kozhikode district and three from Malappuram district while 13 confirmed cases have been reported. Among the 16 suspected cases, 15 are admitted in Government Medical College, Kozhikode, and one is admitted in Manjeri Medical College in Malappuram district.

Nipah virus (NiV) infection is a newly emerging zoonosis that causes severe disease in both animals and humans. The natural host of the virus are fruit bats of the Pteropodidae Family, Pteropus genus. The Ministry had yesterday asked people not to "panic" saying the outbreak was "unlikely" to spread further as early and efficient containment measures were being taken. It had also said that the outbreak appeared to be a "localised" occurrence.

The central team from National Centre for Disease Control (NCDC) has already visited the house in Kerala's Perambra from where the first death was reported, and found many bats in a well from where the family took water. The outbreak of the disease was first reported in Kampung Sungai Nipah, Malaysia in 1998. Intermediate hosts of this instance were found to be pigs. According to a health ministry official, the infection has a high mortality rate. Earlier, cases of Nipah virus were reported from Siliguri in 2001 and Nadia in 2007 in West Bengal and around 47 deaths were reported.

According to WHO, human infections range from asymptomatic infection, acute respiratory infection (mild, severe), and fatal encephalitis. Infected people initially develop influenza-like symptoms of fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.

The incubation period (interval from infection to the onset of symptoms) is believed to range between from 4-14 days. However, an incubation period as long as 45 days has been reported. The virus spreads through close contact with people's secretions and excretions. Eating food which may have the droplets of saliva of infected bats can lead to the transmission of the virus.