Neighbouring districts of Kozhikode and Mallappuram in Kerala have been put on "high alert" by a central health ministry team sent to the state in the wake of the outbreak of Nipah virus, which has already led to at least 11 deaths.
In an advisory, the central tram has also asked for setting up of screening facilities of suspected cases at the exit and entry points of these districts.
According to the ministry, out of the 11 deaths so far due to the virus, eight persons have died in Kozhikode district and three in Mallappuram. Besides, nine persons were undergoing treatment and isolation wards have been opened in several hospitals in Kozhikode.
The advisory has also asked the administration to ensure availability of isolation and emergency management facilities before referral. The local administration, with the help of central team, has set up a task force with a designated control room while a nodal officer has been appointed to collect data and monitor the activities to ensure preventive measures.
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 central team has collected samples of rabbits and pigeons in the area to ascertain if they are alternate source of infections.
"The central team has asked the neighbouring districts of Kozhikode and Malappuram in to be on high alert and ensure screening of those who have symptoms of fever, nausea, respiratory distress, at the exit and entry points.
"It has also asked them to ensure availability of isolation and emergency management facilities before referral," a senior health ministry official said.
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) team 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.
Sixty different samples have been collected from the spot and sent for examination. Hospitals in the public and private sector have been provided with personal protective equipment, and appropriate steps to contain this virus have been taken among domestic animals such as pigs, the Ministry said.
The Ministry said that the Virus Research Diagnostic Laboratory at Manipal Hospital and the National Institute of Virology have been asked to meet the diagnostic challenges. Currently, there is no vaccine or drug for the treatment of the NiV infection. The treatment for human cases is supportive and management treatment along with intensive supportive care.
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 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.
Most people who survive acute encephalitis make a full recovery, but long term neurologic conditions have been reported in survivors. 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.
According to the National Vector Borne Disease Control Programme, the drug ribavirin has been shown to be effective against the viruses in viro, but human investigations to date have been inconclusive and the clinical usefulness of the drug remains uncertain.
According to another 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.
Dr Suryanarayana Sharma, Neurologist and stroke specialist, BGS Gleneagles Global Hospital Bengaluru said that one should avoid contact with bats or its faecal droppings and pigs. Additionally, one should avoid fruits that may be half eaten by bats, as these may carry the virus.
One should also avoid eating fruits in open places and wash, peel or cook fruits before eating. Health care settings must practice strict isolation measures and ensure safety of the health care providers to contain this disease outbreak, Sharma said.
"Wide spread panic and lack of preparedness for newer forms of rare viral diseases is quite difficult to handle. Public awareness, education and Do's and Don'ts through various media channels should be carried out for Nipah virus flu," said Dr Usha Manjunath, Director IIHMR (Institute of Health Management and Research) Bangalore.
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