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Deadly outbreak | Nipah virus

A zoonotic disease that jumped from animals to humans, NiV highlights the reality that human activities are driving the emergence of new global pandemics.

The Nipah virus outbreak in Kerala in 2018 was, looking back, the first major outbreak that people could remember. In a society accustomed to fast-paced narratives and thrilling stories of diseases, horror, and death, the 2018 Nipah virus (NiV) outbreak turned into a horrifying reality. In the recent outbreak in Kozhikode, six individuals tested positive, and two lost their lives. NiV, with its recurrent outbreaks in Kerala (now the fourth), has come to symbolize the fear and helplessness surrounding emerging diseases in the modern era.

NiV is a zoonotic disease that made the leap from animals to humans through a 'zoonotic spillover,' underscoring the fact that human-driven causes are responsible for the new pandemics worldwide. With these diseases emerging frequently, disrupting daily life and altering societal norms, it's crucial for those in positions of authority and healthcare professionals to recognize the evolving dynamics of diseases and address healthcare more comprehensively.

The name 'Nipah' originated from a Malaysian village where the first outbreak was reported in 1998. Initially, symptoms resembled encephalitis, but doctors soon realized that, in addition to neurological symptoms, there was acute respiratory distress syndrome, respiratory failure, and multi-organ dysfunction syndrome. Over time, the world learned about this new disease strain caused by a paramyxovirus, with pigs and fruit bats as vectors. Since then, India has witnessed several NiV outbreaks, primarily in Kerala (2018, 2019, 2021, and 2023), as well as in Siliguri in 2001 and a relatively small outbreak in Nadia, West Bengal, in 2007.

No licensed treatment
In Kerala, fruit bats are believed to be the primary reservoirs of infection, with the consumption of fruits or berries contaminated with bat saliva potentially causing the outbreaks. In other regions like Bangladesh and West Bengal, the consumption of date palm sap, also contaminated by bats, has been linked to outbreaks. Currently, there are no licensed treatments available for NiV infection, according to the Centers for Disease Control and Prevention. Treatment mainly involves supportive care, including rest, hydration, and symptom management. Some doctors have reported that the antiviral drug Favipiravir has shown some effectiveness against NiV. The m102.4 monoclonal antibody is also undergoing development and evaluation.

It was in 2018, when NiV struck Kozhikode district in Kerala, resulting in 21 out of 23 infected individuals losing their lives, that both the healthcare system and the public's attention were involuntarily drawn to the virus. Kerala's handling of the outbreak offered valuable lessons for dealing with public health emergencies, including patient isolation, contact tracing, quarantine measures, triage, and the implementation of infection control protocols.

Human-to-human transmission was how Patient Zero, Mohammed Salih, from Perambra in Kozhikode, contracted the virus. His brother had succumbed to similar symptoms the previous week. Even in the recent outbreak, healthcare workers were affected, indicating the potential for nosocomial transmission. The high mortality rates, along with the risk to healthcare workers and the possibility of multi-modal transmission, raised concerns.

It's now evident that addressing a single outbreak is not sufficient. Larger factors are at play, and a comprehensive approach to healthcare is required. Nations must recognize that human activities such as rapid expansion of agricultural lands and the destruction of natural habitats for wildlife, compounded by climate change, are contributing factors. The 'One Health' approach is increasingly being advocated. According to the WHO, 'One Health' is an integrated, holistic approach to optimizing the health of people, animals, and the environment. It's essential for preventing, predicting, detecting, and responding to health threats.

Ideally, this approach involves collaboration across multiple sectors, disciplines, and communities at various societal levels to tackle root causes and establish long-term, sustainable solutions. 'One Health' encompasses public health, veterinary medicine, and environmental concerns and is especially relevant for controlling zoonotic diseases.