A reminder from Kerala on Nipah

The death of a 12-year-old boy in Kerala has brought back focus on the threat from the Nipah virus. Like Sars-cov-2, it is zoonotic, having jumped from animals. The virus is carried by fruit bats and infection spreads when a person eats or drinks something contaminated by bat droppings. Nipah infections have a high fatality rate; 17 of the 19 confirmed cases in Kerala in 2018 died. The World Health Organization estimates 40-75% of the infections are likely to be fatal. Experts have warned of a high pandemic potential with a virus such as Nipah. Till now, cases of human-to-human transmission are few compared to infections via contact with animals or contaminated products. But a 2019 study in the New England Journal of Medicine raised the possibility of the virus mutating to become more able to jump from person to person, making any outbreak a cause for significant concern.

This is of relevance to India. Kerala, except for 2020, has reported Nipah outbreaks. After being seemingly caught off guard in 2018, the state put in place protocols to carry out widespread contact tracing and testing efforts. The following year, when a student was found infected, 329 people who had come in contact were traced, potentially preventing more cases. No deaths took place that year. This year, the state has identified 250 people, and 11 showing symptoms are being tested. Covid-19 has demonstrated that not all states have the resources or the expertise to mount a robust test-trace-treat campaign. If the virus spreads in a state with inferior surveillance, it could escalate into an epidemic. Nipah, in the time of Covid-19, should serve as a reminder to build up India’s health infrastructure.