Nipah Outbreak: Questions being asked about Kerala’s public health system to detect ‘exotic’ diseases

State health minister though insists that Kerala has a fool-proof system to detect any illness

By K A Shaji
Published: Wednesday 13 September 2023
Experts from the National Institute of Virology will conduct a survey of bats in the affected area of Kozhikode. Seen here is a roost of Flying foxes. Photo: iStock

Experts have raised questions about the preparedness of Kerala to detect exotic diseases as the wake of the latest Nipah Virus (NiV) outbreak in the state.

Two people have died and two others have been hospitalised, one of whom is in critical condition in the latest outbreak. The state government has set up a control room to monitor the evolving situation.

Before this week’s outbreak, NiV was first reported in the state in 2018 in Kozhikode district.

In the last decade, Kerala has also witnessed at least 10 viral and non-viral disease outbreaks, ranging from chikungunya, dengue, Japanese encephalitis, and acute encephalitis syndrome to West Nile encephalitis, viral hepatitis, swine flu, COVID-19 and mpox, besides NiV.

Epidemics are making regular returns, posing severe challenges to Kerala’s once-hailed, robust healthcare system. Experts this reporter spoke said the state’s preparedness in this matter was of concern.

Facilities in Kerala to monitor the arrival of rare infections are very limited, according to Dr T Jacob John, former director of the Virology Research Centre at the Indian Council of Medical Research.

“The state has only a health department. But we have no public health department. The state lacks a complete and fool-proof monitoring facility. Developing immunity among people remains a major task for the government. Kerala needs an integrated disease surveillance system,” he says.

“I do agree that the latest Nipah outbreak would end soon in the face of effective intervention. It would not evolve into a health emergency. But authorities must use the present challenge to check the efficacy of the state’s disease surveillance system and public health preparedness,” said public health activist G R Santhosh Kumar.

“It would be difficult for Kerala to move forward depending largely on the healthcare sector’s glories and laurels of the past. We are now adopting a curative care or clinical model in which people get affected by the disease and extend treatment later. But the focus must be on developing the immunity of the people to resist such infections. We need to listen to experts from outside and strengthen the public health system by developing people’s immunity,” he said.

However, Mohammed Asheel, who coordinated Kerala’s fight against epidemics for many years in the recent past as then executive director of the Kerala Social Security Mission, differed.

“Kerala’s public health system has evolved enough to handle the situation. Now, we have better systems for surveillance and response. There is no need for people to get unnecessarily panicked. The state is keeping strong vigil and adopting proper public health actions,” he said.

Kerala’s vulnerability to new and emerging diseases is real, and the stress must be on preparedness and effective health interventions to face the challenge, Asheel added.

“Because of the strong awareness drives we initiated in the past, people could easily detect the new cases and approach hospitals. So the state was able to respond to the threat quickly,” he noted.

It is a view that the state health minister Veena George has echoed. The minister claimed the state has a well-established surveillance mechanism that remains intact.

She said the Nipah control protocol has effectively been followed without delay, and mass testing has begun in the area where the latest virus cases were found.

George added that the government has already ensured total surveillance through contact tracing, categorising them into low- and high-risk groups, setting up isolation facilities, demarcating containment zones, and procuring medicines for those infected.

‘Exotic’ illnesses

Some experts cite Kerala’s geography as a reason for the frequency of outbreaks. Wildlife and animal husbandry experts believe the state’s sizeable forest cover and intense monsoon pattern make it susceptible to outbreaks.

Keralites are known for traveling worldwide, and many diseases like mpox came to the state through travellers. The first COVID-19 case in India was reported in Kerala by a medical student who returned from Wuhan, China.

Kerala’s dependency on neighbouring states for livestock and poultry remains a concern. The state also has several wetland areas that attract migratory birds that may carry the viruses.

One of the two victims of the latest outbreak, Mohammed Ali suffered from liver cirrhosis and also had some comorbidities. He died at a private hospital following a high, unnatural fever.

Later, doctors at another private hospital suspected Nipah when four members of his family were admitted there on September 9-10, 2023, with symptoms atypical of fever and pneumonia.

The condition of his nine-year-old child, who is on ventilator support, is critical. Two other children are stable, and three of his family members are in isolation at the hospital.

Meanwhile, the other deceased person, Mangalatt Haris, was admitted to the same hospital on September 11 with fever and pneumonia-like symptoms. The man died of cardiac arrest after his condition worsened.

When Haris’ contacts were tracked, it was found that he had come into contact with Mohammed Ali at the private hospital where the latter was admitted.

According to George, the virus strain detected in Kozhikode this time is the Bangladesh variant that spreads from human-to-human and has a high mortality rate. But the minister said it is less infectious.

About 130 people have been tested for the virus in the last two days in Kozhikode alone because of the symptoms of the infectious disease.

Meanwhile, like in 2018, experts from the National Institute of Virology (NIV) in Pune will arrive in northern Kerala in the next two days, along with a group of epidemiologists from Chennai, to conduct a survey of bats in the region.

While the first outbreak extended to the Prambra block Panchayat areas of Kozhikode, this time, the threat is limited to the Gram Panchayats of Villiappally, Purameri, Ayancheri, Maruthonkara, Thiruvallur, Kuttiyadi, Kayakkodi, and Kavilumpara.

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