In October 2023 the WHO issued a statement with updates about the outbreak of Nipah virus that was reported in India last month. The update confirms the number of laboratory confirmed cases and deaths and states that “no new cases have been detected”. The Ministry of Health and Family Welfare initiated a rigorous contact tracing, quarantine, and monitoring process, involving 1288 contacts and healthcare workers.
The start of the outbreak
From 12th to 15th September 2023 the Ministry reported six laboratory confirmed cases, including two deaths, in Kerala. The source of infection for the first case remains unknown, but the following cases were family and hospital contacts of the first patient. The confirmed cases are reported to have been males between the ages of 9 and 45.
The Government responded with stringent measures including the declaration of containment zones in nine villages in the district, with movement restrictions, social distancing, and mandatory mask-wearing in public spaces.
“State and national authorities activated a multisectoral coordination and response mechanism to contain the spread of the outbreak.”
This included enhanced surveillance and laboratory testing, hospital preparedness for case management, and risk communication and community engagement. On 27th September 1288 contacts of the confirmed cases had been traced, and since 15th September no new cases have been detected.
The National Institute of Virology (NIV), Pune, suggests that the virus has been identified as the Indian Genotype (I-Genotype), which is like the strain of Nipah virus that is found in Bangladesh. The case fatality rates in outbreaks in Bangladesh, Inia, Malaysia, and Singapore are suggested to range from 40% to 100%.
A swift and strict response
WHO states that public health measures were implemented including:
- Coordination
- Surveillance and contact tracing
- Laboratory testing
- Health facility preparedness
- Infection prevention and control
- Logistic management
- Dead body management
- Risk communication and community engagement
- Animal sector
Source identification
Despite a recent survey in India identifying Nipah virus in fruit bats across much of the country, a sample of bats, animal droppings, and half-eaten fruits were collected on 15th from the village of the first case. Of a 300-acre forest, home to several bat species, all samples tested negative for Nipah virus.
The unknown source is a contributing factor to the risk assessment by WHO, which also considers the high reported case fatality rate and high number of contacts, as well as the ‘absence of Nipah virus-specific therapeutics and vaccines”.
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