Kerala learns from previous Nipah outbreaks to prime future response

Kerala's public health system learns from Nipah outbreaks, develops clinical algorithms, diagnostic facilities, and infection control practices.

The fear of another Nipah virus outbreak is receding from Kerala as yet again, the State seems to have managed to contain the outbreak to the lone index case.

In 2018 when Nipah surfaced in Kerala for the very first time, it took the entire public health system by surprise and laid bare the gaping inadequacies in the system. But the disease then became an opportunity for the State to develop a clinical algorithm for all emerging viral infections at tertiary care levels, and to strengthen diagnostic and research capacities and improve standard infection control practices in hospitals.

Come 2024, clinicians in the State have become adept at maintaining a high index of suspicion when they encounter unusual cases of acute encephalitis syndrome (AES). They have learnt to watch out for any clustering of AES cases of unknown etiology and to act swiftly -- fast diagnostics and amping up of standard infection control protocols in hospitals -- so as to prevent any human-to-human transmission of the infection.

“One of the major activities that developed in most medical college hospitals in Kerala after the 2018 NiV outbreak was the establishment of a clinical algorithm-based screening protocol for all emerging infections, using molecular diagnosis testing through Multiplex PCR platforms”, points out R. Aravind, Head of Infectious Diseases, Thiruvananthapuram Government Medical College.

“This intense focus and look out for new and emerging pathogens is what has helped our clinicians diagnose six or seven cases of primary amoebic meningoencephalitis in recent times -- a rare and highly fatal infection -- the timely diagnosis of which helped save lives,” he says.

All cases of AES are now tested using multiplexPCR to narrow down a diagnosis. Many private hospitals are also using the Truenat point-of-care, rapid molecular test for diagnosis of infectious diseases. The State has also developed advanced diagnostic facilities and has its own BSL 2 Plus virology labs at the Institute of Advanced Virology (IAV) and Kozhikode Medical College.

Another valuable lesson that emerged from the Nipah experience was the need to invest in standard infection control practices in all hospitals. The State’s first brush with Nipah had been catastrophic -- 19 persons became infected from the index case, primarily because of poor infection control practices within hospitals