Kerala, for the fourth time since 2018, is facing the threat of the deadly Nipah virus. The current outbreak is occurring in the North Kerala district of Kozhikode, marking the third time it has returned to this region.

The experiences and lessons learned from previous encounters with Nipah, combined with dealing with the Covid-19 pandemic in 2020 and 2021, have equipped Kerala to confront the virus once again in its fourth resurgence in Kozhikode.

The First Outbreak in 2018:

The 2018 outbreak caught the state’s health department off-guard, resulting in 17 deaths out of 18 confirmed cases. The government had no prior experience in handling a disease with such a high fatality rate. It was identified only after the virus had already started spreading among humans.

The response followed the protocol for the Ebola virus disease, which was primarily reported in sub-Saharan Africa. Concepts like social distancing, contact tracing, and isolation were introduced to Kerala. Health workers in personal protective equipment became a common sight.

Despite limited knowledge at the time, a coordinated effort was initiated for containment. The health department, along with the revenue district administration, led coordination efforts among various stakeholders. Contact tracing, home quarantine for all contacts, and psychological support through a call center were introduced. Isolation wards were set up, and ad-hoc committees were formed.

Developing a Protocol:

In 2019, the health department issued a Nipah virus infection control guideline. As Nipah cases continued, the health department worked on building structures and processes to deal with future outbreaks. A resource group of senior doctors and WHO representatives were involved in protocol preparation, leading to comprehensive guidelines covering diagnosis, surveillance, treatment, and sample collection.

Handling Nipah Amid the Pandemic in 2021:

In 2020, Kerala reported no Nipah cases, but the 2019 protocol was updated and circulated. It was further enhanced in 2021. When a 12-year-old boy died due to Nipah in September 2021, Kerala was simultaneously dealing with the Covid-19 pandemic. The public’s familiarity with quarantine and isolation measures due to Covid-19 facilitated Nipah control.

Advancements in Detection:

In 2018, Kerala lacked the lab facilities for Nipah virus diagnosis. Samples were sent to Manipal Centre for Virus Research (MCVR) for confirmation. In 2019, a PCR assay and ELISA testing facility for Nipah detection were established in Kochi. Government labs were upgraded, mainly due to the Covid-19 pandemic.

In 2023, Nipah was detected at the biosafety level-2 lab in Kozhikode, with confirmation from NIV Pune. The state has multiple virology labs and a mobile lab in Thiruvananthapuram. Detection times have significantly improved.

Managing Nipah in 2023:

In the latest outbreak, the health department acted swiftly based on previous experiences and protocols. The department initiated control measures even before lab confirmation, demonstrating a proactive approach. A Nipah core committee and a control room were established. Isolation facilities and contact tracking were activated.

Infection Control System in Hospitals:

A similarity between the 2018 and 2023 outbreaks is the role of hospitals in virus transmission. In 2018, inadequate infection control measures in hospitals led to exposure of health workers. In 2023, it was found that the index case had contact with the second victim at a private hospital, leading to a cluster at the latter’s home. Enhanced infection control measures are now being implemented.

Kerala’s journey in battling Nipah virus reflects the importance of preparedness, continuous learning, and adapting protocols over time to effectively manage emerging infectious diseases.

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