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The recent confirmation of Nipah infection in Kerala has once again put the state on high alert. The National Virology Institute in Pune confirmed the infection as the cause of death of a 24-year-old man in Malappuram district, marking the resurgence of the deadly zoonotic disease.
The development has triggered swift containment efforts by the health department as they race to prevent another outbreak. Authorities have designated five civic wards in the area as containment zones and made face masks mandatory. Educational institutions, along with cinema theatres, have been closed. However, shops are permitted to operate from 10 am to 7 pm. Residents have also been advised to avoid social gatherings.
India’s first case of Nipah was reported in Kozhikode in May 2018. Since then, Kerala has witnessed 22 fatalities attributed to the virus.
In 2019, a patient in Ernakulam district recovered after treatment, but a 13-year-old boy from Choloor near Kozhikode succumbed to the infection in 2021. More recently, two out of five cases in Kozhikode ended in death in 2023. On July 20 this year, a ninth-grade student died from Nipah in Pandikad, Malappuram.
The latest fatality was a 24-year-old MSc psychology student who had returned to his home in Malappuram from Bengaluru on August 23. After experiencing difficulty walking, he sought treatment but developed a fever on September 5.
Over the next few days, the student visited multiple hospitals in search of relief. He was finally admitted to a private hospital in Perinthalmanna, where he passed away on September 9. He was buried the following day. It wasn’t until September 15 that authorities confirmed the presence of Nipah virus after samples were analysed at Kozhikode Medical College and Pune’s Virology Institute.
Health officials, already on high alert, have ramped up efforts to trace and test individuals who had contact with the deceased. According to Kerala Health Minister Veena George, around 175 people who had been in contact with the victim are being treated at Manjeri Government Medical College Hospital for suspected Nipah symptoms. The health department has released the victim’s travel history, detailing his movements and interactions leading up to his death, in hopes of identifying potential sources of transmission.
In line with the state’s Nipah protocol, 16 committees have been established under the district administration to manage the situation. Field surveys within a 3-kilometre radius of the deceased’s home are underway, with 66 teams deployed to monitor the area.
While initial suspicions point to the consumption of Averrhoa bilimbi, a fruit known locally as Irumpanpuli, which may have been contaminated by bats, experts remain cautious about attributing the outbreak solely to bats.
Despite the ongoing destruction of bat colonies in the state, health authorities have not confirmed a definitive link between bats and the Nipah virus in Kerala. Previous tests have cast doubt on the theory that bats are the primary carriers in this region, leading some public health experts to speculate that a different variant of the virus may be at play. This variant may not be directly linked to bats, as is the case in outbreaks in northeastern India and Bangladesh.
One of the challenges in containing Nipah outbreaks is the absence of advanced virology testing facilities within the state. Although the Kozhikode Medical College began constructing a Bio Safety Level-3 (BSL-3) laboratory after the 2018 outbreak, progress has been slow.
The project, originally sanctioned in 2019, was delayed due to the COVID-19 pandemic and is now expected to be completed by the end of this year. Currently, Kerala relies on the National Institute of Virology in Pune for final confirmation of viral diseases, causing delays in diagnosing and managing infections.
The completion of the BSL-3 lab in Kozhikode is critical, as it would allow for faster and more accurate testing of samples, enabling health authorities to act swiftly in response to outbreaks. A similar facility is also under construction in Alappuzha. These labs, once operational, will strengthen the state’s capacity to detect and manage zoonotic diseases, including Nipah, monkey fever and West Nile fever.
Experts have also pointed to environmental factors that may be contributing to the recurrence of zoonotic diseases in Kerala. The state’s dense forest cover, coupled with climate change and increased human-animal interaction, makes it a hotspot for diseases that jump from animals to humans.
“Nipah virus circulated naturally in fruit bats and climate change could contribute to the spread of certain viruses,” Rajeev Jayadevan, chairman of the state IMA research cell, stated.
A Althaf, a public health expert from Thiruvananthapuram, noted that all Nipah victims in Kerala so far have been young males between 12 and 25 years of age — active and adventurous individuals, which may put them at higher risk of exposure.
As Kerala battles yet another Nipah scare, health professionals are calling for improved public health infrastructure and greater awareness of zoonotic diseases. Dr Dipu TS, an infectious diseases expert, emphasised the need for better planning and preparedness, especially in high-risk regions.
There are concerns that environmental degradation, particularly in regions like Kozhikode and Malappuram, may also be exacerbating the problem. “Mangroves, urban forests and other environments conducive to bat populations — are present throughout Kerala. Thus, the risk of Nipah outbreaks could extend beyond the current hotspots,” stated an animal pathologist who researched bats in Kozhikode.