Nipah virus toll in Kerala rises to 10; will Hep C drug provide a cure?

The Nipah Virus outbreak in Kerala, which has reportedly taken a toll of at least 10 lives so far, has brought the State under panic. At least eight others have been admitted to hospital with the symptoms of the Nipah Virus, a pathogen that is said to be transmitted through bats and animals. 

The State government has said that it has effectively curbed the spreading of the disease, while neighbouring Tamil Nadu has urged people to avoid travelling to the area in Kerala where the virus has been identified.

Meanwhile, Lini (31), the nurse at Perambra Taluk Hospital whom reports said could have contracted the virus because she was exposed while tending to an infected patient, died on Monday without even getting a chance to bid adieu to her loved ones.

With her demise, the toll has now gone up to 10. On Sunday, the toll had risen to nine with the death of six more persons who had shown symptoms of the disease. Of these, two deaths were reported from Kozhikode and four from Malappuram district. 

Meanwhile, Kerala Chief Minister Pinarayi Vijayan said his government was monitoring the situation. “All efforts are also being made to ensure that more lives are not lost,” Vijayan said, adding that the government was handling the issue with ‘utmost seriousness’.

The health and labour ministers have camped at the district to lead efforts in this direction, and private hospitals have been instructed to not deny treatment for anyone suffering from fever, the Chief Minister's Office said. An expert medical team of the Union government with experts from All India Institutes of Medical Sciences (AIIMS) has arrived on the state's request.

Kerala Health Minister K K Shailaja added that the government has taken measures to control the situation. 

"All the periphery hospitals of Kozhikode Medical College Hospital are fully equipped to tackle the fever. All those who have fever need not rush to the medical college. Patients samples have been sent to Pune and results are awaited," she said.

While the virus has been reported only in Kozhikode, a statewide alert has been issued.

The National Institute of Virology has confirmed from the studies on blood samples that three of the four deaths in the initial stage attributed to fever were caused by the virus. The first of these was reported on May 19, and the Union Health Ministry and World Health organization were contacted on that day itself, said the State government.

No cure, only prevention

Experts and reports said that while no vaccine is available, preventive measures can be a key to controlling the spread. 

Since fruits bats are the primary cause of infection, livestock should be prevented from eating fruit contaminated by bats. Consumption of contaminated date palm sap, including toddy, should also be avoided. Physical barriers can be put up in order to prevent bats from accessing and contaminating palm sap.

The infection presents as an encephalitic syndrome marked by fever, headache, drowsiness, disorientation, mental confusion and coma that can lead to death. The virus can be transferred from a human through close contact, body fluids, saliva and cough.

George M Varghese, Associate Professor, Department of Medicine & Infectious Diseases at the Christian Medical College, Vellore, said that how the virus has appeared in North Kerala has to be looked at, for effective precaution. It was previously reported in Malaysia and Bangladesh, and in Siliguri, West Bengal. 

By nature, the fruit bats will not travel beyond a 50-km radius and no case has been reported in neighbouring areas. One risk factor is the large-scale import of dates by North Kerala during the Ramzan season. If the fruit becomes contaminated, there could be an outbreak. 

Human-to-human transmission has been confirmed with the death of the nurses involved in the treatment and precautions have to be taken, since the disease may spread through body fluid such as patient's saliva.

There is no vaccine for the disease and the primary treatment is intensive supportive care, according to WHO. However, Varghese said that an anti-viral drug, Ribavirin, might have some effect on the disease. The medication is also used in the treatment of Hepatitis C.

The disease spreads through fruit bats or ‘flying foxes,’ of the genus Pteropus, which are natural reservoir hosts of the Nipah and Hendra viruses. The virus is present in bat urine and possibly in bat faeces, saliva, and birthing fluids. Presumably, the first incidence of Nipah infection occurred when pigs in Malaysian farms came in contact with bats that had lost habitat due to deforestation. Transmission between farms may also be due to fomites – or carrying the virus on clothing, equipment, boots, vehicles.

The virus can be transferred from a human through close contact, body fluids, saliva and cough.

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