Nipah Virus Outbreak IN Kerala-2018

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Muns
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Re: Nipah Virus Outbreak IN Kerala-2018

Postby Muns » 31 May 2018 07:11

Well done Ramana Garu.

Reading some more about this it seems that the first victim to get infected was Mohammed Sabith. Thereafter he passed this on to four members of his family, including his brother.Mohammed Salih and their aunt Maryam
He recently returned from Dubai however. It'd be interesting to know if he came across any Bangladeshis in Kerala as well.

But considering the high rate of mortality... These refugee Bangladeshis should have died too?

Also to confound the case even further. Kerala health authorities seem to have sent the wrong bats for testing.

It seems that the reservoir is really fruit bats but the bats that got sent for testing were actually insectivore bats.
They are multiple articles that state to that by the time the actually test the fruit bats they might be negative as the virus will be cleared.

However from what I understand they are two tests. The Elisa test being the antibody test would be first initial test to for the antibodies with the later PCR test which is the DNA test to come later As a confirmatory test. Kind of what we really do with HIV.

Even of the DNA test is negative the Elisa test or antibody test should still be positive for Nipah virus in the bats.

It looks like now two more people may have succumbed to the virus.

Two more succumb to Nipah infection
http://www.thehindu.com/news/national/k ... 040118.ece

Death toll at 16. One of the new to have succumbed is a lorry driver.

Hmmm.... I might make a video on this taking some of the news from above. If it's all right with everybody.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 31 May 2018 07:29

ramana, you mention encephalitis. There was this regular and mysterious outbreak of 'Japanesee encephalitis' in Bihar which used to kill so many apparently healthy children all of a sudden every year. Children would be all right one day but by next night they would be dead. Even those immunized against that disease died. A couple of years back, it was determined that it was not Japanese encephalitis but some toxins in the common litchi fruits that led to hypoglycemia in children very quickly. This year, these deaths should be very little, hopefully eliminated.

I came to know during the course of following this Nipah virus that there is an 'India Epidemiological Intelligence Service' !

Anyway, great suggestion by you that has now been proved.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 31 May 2018 08:04

https://www.indiastat.com/health/16/dis ... stats.aspx

This gives stats.Need people to help do the analysis.

Muns please do a video and put on YouTube as public service.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 31 May 2018 15:02

Two more succumb to Nipah infection - The Hindu
Two more persons succumbed to the Nipah virus infection in the State on Wednesday as the death toll now stands at 16.

Health authorities gave their names as T.P. Madhusoodanan, 54, of Nellikkode, and Akhil, 28, of Nellikkaparambu at Kodiyathoor, both in Kozhikode district. Madhusoodanan was a senior superintendent at the district court, Kozhikode.


Death of soldier leads to Nipah scare in Kolkata - The Hindu
The death of a 27-year-old soldier hailing from Kerala has set off fears that he may have been infected with Nipah. Seenu Prasad, was admitted to Kolkata’s Command Hospital on May 20 and he passed away on May 25.

“His body fluids have been sent to the National Institute of Virology in Pune,” said Wing Commander S.S. Birdi, Chief Public Relations Officer in Kolkata for the Ministry of Defence.

According to authorities, the soldier had gone on a month’s leave to Kerala and joined duty on May 13. He was posted at Fort William, the headquarters of the Army’s Eastern Command.

Meanwhile, three patients have been moved to the isolation ward of the Infectious Diseases Hospital at Beleghata in Kolkata after they showed symptoms of viral contamination. Two of them are from Domkal in Murshidabad district and the third is from Ghatal in Paschim Medinipur. They had visited Kerala for work in the past few weeks.
Last edited by ramana on 31 May 2018 20:47, edited 1 time in total.
Reason: Added underline to show location ramana

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 01 Jun 2018 11:35

Bid to thwart second wave of Nipah - The Hindu
Efforts to thwart the advance of a second wave of Nipah virus infection are on in Kerala even as one more death was reported from Kozhikode district on Thursday. This is the third death in two days, taking the total death toll in the State to 17.

Rasin, 25, son of Bhaskaran of Kottoor {Malappuram ?} grama panchayat in the district, succumbed to the infection at the Government Medical College Hospital (MCH).

R.L. Saritha, Director, Health Services, told the media that he was admitted to the hospital on May 26. He was on the contact list of persons who were suspected to have contracted infection from those who died earlier. Rasin is believed to have got the infection from Ismail when both of them were undergoing treatment at the Balussery taluk hospital.

Ismail was later referred to the MCH, where he died due to Nipah infection on May 20. However, the authorities are yet to figure out the source of infection of Akhil, who died on Wednesday.

Dr. Saritha said that Rasin did not have any contact with the family members of V. Moosa of Chengaroth, near Perambra, who are considered to be the first source of infection {Is there any information on how Moosa's family contracted the virus?} . As he contracted it from a second source, the department has now begun activities considering this as a second wave of infection, she pointed out.

More people were getting added to the contact list, which now has 1,407 people in it. Details of the fever deaths and fever cases that were reported in Kozhikode and Malappuram districts in early May and a couple of weeks before that were being collected from government hospitals and private hospitals. All the probable deaths would be examined and all those related to them would be kept under watch to widen the contact list. Any one exhibiting symptoms could approach the 24x7 helpline set up at the government guest house at 0495-2381000. Ambulance services had been provided to take the suspected patients to the hospital.

Meanwhile, Dr. Saritha said the two infected persons admitted to the MCH were responding to the treatment and the condition of one of them had improved. The human monoclonal anti-body being procured from Australia would reach here [Kozhikode] soon, she said.

Caution at district court

District Collector U.V. Jose is expected to soon submit a report to the Registrar of the Kerala High Court on the demand by the Bar Association that the ongoing trials at the district court in Kozhikode be stopped for the time being.

This was against the backdrop of the death of a court staff due to Nipah infection on Wednesday. Mr. Jose said that it was better to be cautious as the court premises were always crowded with people.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 01 Jun 2018 11:38

I cancelled my trip next week and airlines took away all the money !!

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby JayS » 01 Jun 2018 11:51

GOI needs to work to keep the virus from spreading outside KL. If it gets out to some big city like BLR, it will be rather difficult to contain because it will have much more ways to spread from there.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby pravula » 01 Jun 2018 13:30

SSridhar wrote:I cancelled my trip next week and airlines took away all the money !!


Depending on what you used to pay, maybe travel insurance can come into play. Some credit cards will cover this.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby kvraghav » 01 Jun 2018 18:42

^^
Will kerala borders be locked down then?

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 02 Jun 2018 00:42

I think.this #Nipah virus deaths were being misdiagnosed earlier as encephalitis.
It was the quick thinking by Dr. G. Arun Kumar that helped identify the real cause.

Very interesting that not one Kerala govt minister is talking despite a contact list of 1400 people.

Total abdication of accountability.
Means they are clueless or hiding scared.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 02 Jun 2018 04:57

Fresh Nipah alert: Kerala tightens monitoring system - ToI
The Kerala government issued a fresh Nipah virus alert on Friday and directed the health administration in all districts to screen people who had close contact with even suspected Nipah patients.

Health minister K K Shailaja said those that had come in contact with Nipah patients should be cautious till the end of the virus’s incubation period and, hence, daily screening of these people has become essential to prevent the spread of the brain-damaging illness. Till now, 16 of the 18 people who tested positive for Nipah virus have died. The condition of the other two patients is stable.

Health department officials say the Nipah ‘contact list’ has been expanded. As of now, there are 1,949 persons in the list who are regularly being monitored by health workers. In another precautionary measure, all nine staff members at Balussery taluk hospital in Kozhikode district have been given leave. Two people, who died of Nipah infection, had undergone treatment at this hospital.

Meanwhile, the experimental drug imported from Australia is learnt to have arrived in Delhi. “Indian Council for Medical Research (IMCR) has suggested that the service of an expert be availed for mixing and administering of human monoclonal anti-body. A decision in this regard will be taken after discussions,’’ said Dr R L Saritha, director of health services.

On Friday, six more persons in Kozhikode were admitted to hospital with symptoms of Nipah,Saritha said.


In Palakkad, district medical officer Dr K P Reetha said that “four patients are under observation in the isolation ward of the district hospital for Nipah virus” with two of them having gone there from Nipah virus-affected Kozhikode and Perambra areas.

The Thamarassery diocese, meanwhile, has decided to alter the serving of Holy Communion, asking priests to place the wafer in the hands of devotees rather than on their tongues. Thamarassery Bishop Mar Remigiose Inchananiyil in a circular also urged believers to follow the directions of authorities to prevent the spread of the deadly virus.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 02 Jun 2018 20:46

Nipah virus: Anatomy of an outbreak - Priyanka Pulla, The Hindu

Very interesting read.
I am not posting it here because it has an interactive part and there are pictures and infographics too.

The young doctors at Baby memorial, Kozhikode, their quick thinking and diagnosis, deserve huge appreciation as also Dr. G. Arunkumar at Manipal.

Also, the responses of the Kerala Health officials, from the DMO all the way up to the Director of Health Services & even the Health Minister are really commendable.

By the way, Nipah is a probable bioterrorism agent, as per the report.

Excerpt
In Kerala, the number of confirmed new cases emerging each day has slowed after the first wave from patient zero. But as the Nipah virus can incubate in the body for up to 21 days, health officials cannot take it easy for a while. Only when 42 days, or two incubation periods, pass after the last confirmed case will the State be declared Nipah-free.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby disha » 02 Jun 2018 21:52

ramana wrote:I think.this #Nipah virus deaths were being misdiagnosed earlier as encephalitis.
It was the quick thinking by Dr. G. Arun Kumar that helped identify the real cause.

Very interesting that not one Kerala govt minister is talking despite a contact list of 1400 people.

Total abdication of accountability.
Means they are clueless or hiding scared.


Thanks for identifying the source. More importantly, we should look at districts with B'Deshi population and correlate with any of JE/Scrub Typhus infection reports.

I do have to bring in Gorakhpur, it was Scrub Typhus which was mis-diagnosed as Japanese Encephalitis. A sustained campaign to vaccinate has reduced the case load. This was actually well managed, given the resources UP has per capita.

Kerala on the other hand has completely botched this, particularly when the second wave of infection is coming through.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby chetak » 02 Jun 2018 22:04

disha wrote:
ramana wrote:I think.this #Nipah virus deaths were being misdiagnosed earlier as encephalitis.
It was the quick thinking by Dr. G. Arun Kumar that helped identify the real cause.

Very interesting that not one Kerala govt minister is talking despite a contact list of 1400 people.

Total abdication of accountability.
Means they are clueless or hiding scared.


Thanks for identifying the source. More importantly, we should look at districts with B'Deshi population and correlate with any of JE/Scrub Typhus infection reports.

I do have to bring in Gorakhpur, it was Scrub Typhus which was mis-diagnosed as Japanese Encephalitis. A sustained campaign to vaccinate has reduced the case load. This was actually well managed, given the resources UP has per capita.

Kerala on the other hand has completely botched this, particularly when the second wave of infection is coming through.


The lorry driver's family/associates should be looked at to see if the driver transported passengers in the cab or in the back. The possibility of beedis hitching a ride, especially to the interiors of the state is fairly likely. Trucks are the preferred mode of transportation for the cash strapped as the drivers charge very little to drop off "passengers" along the way.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby chetak » 02 Jun 2018 22:08

ramana wrote:I think.this #Nipah virus deaths were being misdiagnosed earlier as encephalitis.
It was the quick thinking by Dr. G. Arun Kumar that helped identify the real cause.

Very interesting that not one Kerala govt minister is talking despite a contact list of 1400 people.

Total abdication of accountability.
Means they are clueless or hiding scared.


This is the preferred commie way. Right now they are scared witless and loathe to ruffle any feathers.

In the coming days, after the outbreak has been mitigated, shrill voices will rise, blaming Modi and the RSS for causing/not controlling all this.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 03 Jun 2018 13:49

More confirmation of ramana's hypothesis.

Fruit bats, rabbit test negative for Nipah - ToI
Samples of fruit bats and a rabbit collected from Soopikkada in Perambra, where the first cases of Nipah infection were reported, have also tested negative for the virus. The tests were conducted at the National Institute of High Security Animal Diseases Laboratory in Bhopal. :roll:

District animal husbandry officer AC Mohandas said further epidemiological studies would be carried out on bats and other species till the source of the infection was identified. A team from National Institute of Epidemiology arrived in Kozhikode on Saturday. Samples of bats found in a well in the area tested negative for the virus earlier. Of the 201 human samples tested, 18 tested positive, including the 16 dead.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby arvin » 03 Jun 2018 16:07

https://www.news18.com/news/india/soldi ... 67465.html

The soldier from kerala who died in calcutta has tested negative for nipah as per pune lab. So probably he might have contracted something else in calcutta or on the journey back to base.
I think center should establish a lab of the grade like National Institute of virology, pune in bengal also considering previous incidents and porous border with bangladesh.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby Philip » 03 Jun 2018 18:07

What is the vaccine being rushed to us from Oz.?
We should not take any chances and must get the WHO activated to do a crash course in developing a vaccine.Remember how swine flu spread across the globe not too long ago? Scary.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 03 Jun 2018 18:22

Philip, medical experts may explain better. But, what is being rushed from Oz is not a vaccine, only antibodies to target the specific nipah antigen. Vaccines will challenge and induce our immune system to generate the antibodies , OTOH.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby Philip » 03 Jun 2018 19:08

Tx SS for the explanation.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby chanakyaa » 03 Jun 2018 20:12


ramana
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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 04 Jun 2018 22:15

SSridhar wrote:More confirmation of ramana's hypothesis.

Fruit bats, rabbit test negative for Nipah - ToI
Samples of fruit bats and a rabbit collected from Soopikkada in Perambra, where the first cases of Nipah infection were reported, have also tested negative for the virus. The tests were conducted at the National Institute of High Security Animal Diseases Laboratory in Bhopal.

District animal husbandry officer AC Mohandas said further epidemiological studies would be carried out on bats and other species till the source of the infection was identified. A team from National Institute of Epidemiology arrived in Kozhikode on Saturday. Samples of bats found in a well in the area tested negative for the virus earlier. Of the 201 human samples tested, 18 tested positive, including the 16 dead.

How do they do this test for Nipah virus?

I think immediately National Institute to Virology(NIV) annexes/extension centers should be established in the border states and in all states with Rohingya refugees on a war footing.

Kudos to the Kerala doctors for their steps in containing the spread of Nipah.

They should be given the Padma awards next year.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 07 Jun 2018 01:00

No updates on the Nipah virus?

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby Muns » 07 Jun 2018 04:26

Hello Ramana,

Video on the Nipah virus completed. Think that it is a quite a decent video when it comes to answering all of the basic Q&A regarding the virus. I tried to bring in the Bangladeshi line, but of course unfortunately she refused to comment on the question that was asked. Really dealt with the question of Bangladeshi immigration into India and whether this would constitute a increased risk.

In any case it's planted the seed of thought I guess. Please watch and let me know what you think. Also website has a new and dedicated editor, that is a lot better than my schedule of running things.

Prevention is better than cure to Bat- Out Nipah Virus, say doctors



http://www.india-aware.com

http://www.youtube.com/c/indiaaware

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby Aarvee » 07 Jun 2018 06:41

SSridhar wrote:Philip, medical experts may explain better. But, what is being rushed from Oz is not a vaccine, only antibodies to target the specific nipah antigen. Vaccines will challenge and induce our immune system to generate the antibodies , OTOH.


Correct. This is more a prophylactic preventative treatment. I am not a medical Dr.

And this has been only used once, iirc, in a family that was "possibly" exposed to Hendra.

https://www.brisbanetimes.com.au/nation ... -wm54.html

I am associated with one of the four facilities from the Paper Chanakya has mentioned above.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 07 Jun 2018 09:56

Muns I tweeted it.
Let's see.

Aarvee
Good luck and welcome.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 08 Jun 2018 14:44

Nipah: Centre yet to rule out bats as source - PTI
The Union Health Ministry on Thursday said that bats cannot be ruled out as the primary source of Nipah outbreak, nearly two weeks after a Central medical team told it that samples collected from bats in two districts, where 17 people have died of Nipah infection, tested negative.

On May 26, the medical team in its report to the Ministry said samples collected from insectivorous bats in Kozhikode and Malappuram districts tested negative.

But Union Minister of State for Health Ashwini Kumar Choubey said on Thursday that new samples of 55 fruit bats were collected two days ago and sent to the National Institute of Virology (NIV) in Pune.

The test results of the fresh samples are awaited. R.R. Gangakhedkar, head of the Division of Epidemiology Communicable Diseases, Indian Council for Medical Research, said the previous samples were from insectivorous bats, which were not known to be Nipah carriers, and not from fruit bats.

The Nipah virus stays for a short duration in the body of fruit bats as their system is quite capable of fighting it. So even if a bat has been infected by virus earlier, their samples may test negative later. “Thus, there is need for a larger sample for testing,” he explained.

The Indian Council of Medical Research has suggested that samples of excreta of fruit bats be collected for testing. Mr. Choubey urged people not to panic as the infection has been contained.

Travel history


The Central medical team is examining the travel history of Mohammad Sabith, 26, the first person to die in the Moosa family that lost four members to the virus infection. He had travelled to Saudi Arabia, where he worked as a helper, and returned to India sometime back.

The Central medical team in its report last month had ruled out pigs to be the primary source of the virus.


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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 09 Jun 2018 00:47

The ICMR is playing political games to what purpose I don't understand.

Very clearly it is human contact that has to spread the virus.

And shame on them for misdiagnosing the early cases as encephalitis.
But for the Baby Hospital and Dr. Arun Kumar, they would still be killing bats.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 05 Jul 2018 07:03

Nipah transmission route unclear - Priyanka Pulla, The Hindu
Another piece of the puzzle in Kerala’s Nipah virus outbreak has fallen into place, with Pune’s National Institute of Virology (NIV) confirming that the virus was found in fruit bats captured in Kozhikode. Out of the 51 Pteropus giganteus bats sampled by the NIV team from the Kozhikode epicentre of the outbreak, 11 had genetic material from the Nipah virus.

Strongly indicated

These portions of the viral genome were detected through a test called Reverse Transcriptase Polymerase Chain Reaction, and were 99.68% similar to the virus in patients, NIV Director Devendra T. Mourya told The Hindu . This indicates strongly that the bats were the carriers in the Kerala outbreak.

This is an “important, though not unexpected, finding,” Jonathan Epstein, an epidemiologist studying the Nipah virus at the New York-based EcoHealth Alliance told The Hindu . But researchers still don’t know how the bats transmitted the infection to humans. This information is needed to prevent future outbreaks. In Bangladesh, which has seen multiple Nipah epidemics, patients tend to acquire the infection from drinking raw date-palm sap. But date-palm sap is not consumed in Kerala.

The new finding also highlights the urgent need to step up surveillance of animal reservoirs of disease in India, such as bats and pigs.

The NIV recently found the Nipah virus in fruit bats in West Bengal and Assam, according to a report published in March in the Indian Journal of Medical Research .

Wider surveillance

For the study, the researchers sampled 107 bats from Cooch Behar and Jaipaiguri districts in West Bengal and Dhubri in Assam, all of which are close to Bangladesh, raising the probability that the virus is circulating there. They found nine out of the 107 samples to be positive for the virus. “This indicates that there are several States in India with the virus, which means we need wider surveillance in animals,” said Arunkumar Govindakarnavar, a virologist who heads the Manipal Centre for Virus Research, and wasn’t part of the NIV study.

Low viral load

But the researchers cautioned against bat culling in light of the NIV’s findings. In NIV’s investigations, the number of virus particles in the bats, or viral load, was very low. This means the possibility of a spillover to humans is extremely small.

“Even when viral load is high, direct bat-to-human transmission is very rare, unless you have a scenario like Bangladesh, where people drink palm-sap. That’s why we had only one case of infection from bats in Kozhikode,” said Dr. Arunkumar.



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Re: Nipah Virus Outbreak IN Kerala-2018

Postby kvraghav » 05 Jul 2018 11:02

Isnt Toddy a form of Sap?

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 04 Nov 2018 18:12

A lesson in virus control - Priyanka Pulla, The Hindu
Simple infection-control practices such as isolating sick patients and decongesting common areas in hospitals could have dramatically cut down the toll in the Nipah outbreak this year in Kerala, suggests a paper published in the Journal of Infectious Diseases last month. Though confined to the State, the outbreak in May-June, which claimed 21 lives, drew international interest and raised consternation in India on whether the country was prepared to deal with a novel, killer virus.

By reconstructing the sequence of infections through CCTV footage and interviews with patients, the authors of the paper have concluded that 18 of the 23 patients had caught the virus in two hospitals. Had health-care workers worn masks and gloves and friends and acquaintances been kept away from sick patients, more lives could have been saved, said Arunkumar Govindakarnavar, the lead author of the paper and head of Karnataka’s Manipal Centre for Virus Research. The findings have implications for managing other infectious diseases such as tuberculosis and influenza, because they too can spread through hospitals.

In the Nipah case, the first patient to contract the disease (possibly from fruit bats) was 27-year-old Mohammed Sabith, a resident of Changaroth village in Kozhikode. He was admitted to Perambra Taluk Hospital on May 3. The next day he developed a severe cough and began vomiting, which is when he became a “super-spreader” — a term for the small minority of patients in an outbreak who spread the infection to the rest. Sabith transmitted the infection to 19 others, while the second wave of cases (those who contracted the infection from him) infected 0-1 case each.

This was why it was important to restrict the first wave, but the lack of basic infection control played spoilsport. When Sabith was admitted to the male ward in the hospital, it had 10 patients. Alongside, 10 other people, including friends and health-care workers, entered the ward during the 24 hours he was there. Nine of those 20 succumbed after coming close to Sabith without protection.

Lini Puthussery, the nurse who attended to Sabith, was one of them. She used neither gloves nor a mask. {Some of us involved in Sustainable Waste Management have found that the Corporation conservancy staff simply do not want to wear masks, gloves and aprons supplied to them, in spite of warning about consequences. Just like opposition to helmet wearing from two-wheel riders. Even most of them with helmets on, ride unstrapped. Whom are they cheating? The other day, I saw a photo of TN health secretary at an H1N1 ward without the mask!} Others, who barely knew Sabith, assisted him too. “In the ward, everyone was trying to help each other,” says Govindakarnavar. One of them, a fellow patient, attempted to feed Sabith. A family member accompanying another patient cleaned Sabith’s vomit. These well-meaning acts became death sentences. In contrast, patients who did not come into physical contact — those too sick to get up from their beds, for instance — did not contract the virus. Even a ward attendant who cleaned the patient’s vomit was unharmed as she had followed protocols by using a mask and gloves and disinfecting the floor.

‘Droplet transmission’

“This is a very clear case of droplet transmission. Only those within 1 metre could be reached by the large drops,” said Govindakarnavar.

The second transmission cluster occurred in the corridor outside the CT scan room at Kozhikode Medical College (KMC). When Sabith’s condition worsened, he was referred to the KMC’s emergency ward on May 5. However, within an hour of his admission, he was taken for a head CT scan because he was showing an altered sensorium, says Govindakarnavar. Altered sensorium is a symptom of brain inflammation in which the patient becomes confused or delirious. As a result, the CT lab personnel found it difficult to keep the patient steady, leading to a three-hour delay, during which the patient waited in the corridor. Over the course of three hours, CCTV footage showed over 100 people walking through the 2.5 m-wide space. This led to nine more getting infected, with eight of them succumbing to the infection.

According to Govindakarnavar, there are two takeaways from these findings. “First, basic infection-control practices could have saved lives. Also, hospitals should have case-management protocols for emergency cases.” In Sabith’s case, given his restless state, he should have been stabilised before the CT scan, Govindakarnavar has suggested. This would have protected others in the corridor. Also, there is a need in future to decongest common areas in hospitals by making sure that family and friends do not enter unnecessarily.

This is easier said than done given the overcrowding and understaffing in government hospitals. The KMC draws 6,000 outpatients a day and has 3,500 beds, said Dr. V.R. Rajendra, the principal of the medical college. Controlling crowds would be difficult without a government order, he added. However, according to him, the hospital had now put in place a triage system, which sends patients with severe symptoms to an isolation ward.

Today, in developing countries, poor infection control is a major driver of hospital-acquired infections. A Lancet meta-analysis in 2010 found that that for every 1,000 patient-days in developing countries, intensive-care units saw 47.9 infections, about four times the rate in the United States. The authors called such infections a hidden and serious burden, which could be tackled with low-cost measures such as hand-hygiene.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 15 Nov 2018 04:02

I am closing this thread.
The only missing information is how did Mohammed Sabith first catch the infection?
This is not clear. Every one else is from direct human contact.
The poor fruit bats didn't do it.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 16 Nov 2018 04:39

Journal Of Infectious Diseases, Oxford Uty Pub.

https://academic.oup.com/jid/advance-ar ... ea450bd0e2

Gives the investigative report.
Please read and summarize here.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 16 Nov 2018 13:59

ramana, it is the report from which The Hindu had that article that I posted above.See here

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 16 Nov 2018 23:38

OK. have they determined how Mohd Sabith developed the Nipah infection and is that credible?
To me the root cause is still unknown.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby SSridhar » 17 Nov 2018 04:51

It is the Bangladesh strain but it is claimed that he ate bat-bitten fruits.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby Aarvee » 17 Nov 2018 08:15

TLDR:

* Patient zero probably acquired the infection zoonotically from a fruit bat. No travel history reported. Limited social contact. Nature lover, kept multiple pets. The authors suggest he could have handled a bat (baby bat?) that was carrying the virus.

* Most of the next infections were from patient zero (either family or care givers or people who were unfortunate to have been in physical proximity).

* Median incubation period was 9.5 days. Mortality is 91%.

* The viral sequences show that the virus is similar to the Bangladeshi strain but has some differences .

* The main route of transmission appears to be droplet based (Coughing).

* No indication of infections from corpses even when the handlers didn't wear any personal protective equipment. This is different to what was seen in Bangladesh, where there were significant corpse-human infections.

* Environmental samples at the index patient's home tested negative for the Viral RNA.

* The health system kicked into high gear and ensured the infection spread was curtailed once the identity of virus was confirmed. But most infections were before this and were nosocomial which is again consistent with most outbreaks.

Long version:
Patient zero- a 27 year old previously healthy male. Supposedly a nature and animal lover who kept multiple pets including rabbits and ducks. Died of the disease 3 days post onset of symptoms.
During 2–29 May 2018, 23 cases of NVD were identified, including the index case (not laboratory confirmed), 18 confirmed cases, and 4 probable cases.
All secondary infections happened in the following three hospitals.
Taluk Headquarters hospital, Perambra (hospital 1)
Government Medical College, Kozhikode (hospital 2)
and the Community Health Centre, Balussery (hospital 3)
Of the 22 additional NVD cases identified, 9 primary cases contracted the infection from the index case while he was at hospital 1.
An additional 10 primary cases were infected while the index case was in hospital 2.
The cases at hospital 1 comprised immediate family members, patients admitted in the same ward, companions of patients admitted in the ward, and caregivers of the index case in the ward during the night of 4 May. The mother of case 1, present throughout his illness, did not become ill. She was observed to wear a long scarf on her head. She reported being uncomfortable with the indoor smell of hospitals and therefore covered her nose with the scarf while in the hospital. The brother and father had longer and more intimate contact with the index case, compared with the mother. Sick patients who were restricted to their beds were not infected.
The cases who contracted infection from the index case at hospital 2 were patients or companions/caregivers who were present in the emergency department or in the corridor outside the CT room during the period when the index case was waiting to undergo CT. The patient spent approximately 3 hours in the corridor, during which 3 attempts were made before CT was successful. Based on the surveillance footage, at least 70–100 people potentially had contact with case 1 in the corridor, of whom 10 contracted the infection. Cases 12–18, 20, and 21 were present in the corridor during the same period as case 1. They were either patients or companions of patients. Case 19 was an assistant in the radiology department.
Three other cases were secondary and contracted the disease at hospital 2 and hospital 3 after primary cases sought care.
Case-fatality rate was 91%, with 21 individuals dying and 2 surviving.
Of the 23 cases, 18 provided clinical specimens. All 18 had at least 1 specimen that tested positive for NiV by real-time RT-PCR and negative for all other causes of encephalitis or respiratory infections. Among the 18 cases, 13 had anti-NiV IgM antibody, of whom 4 also had anti-NiV IgG antibody. Five cases did not have either IgM or IgG antibodies to NiV.
The NiV from Kerala was similar but not identical to NiV genotype B. The gene encoding fusion protein (MH891776) was highly conserved, i.e. distinct enough to the Bangladeshi strain gene.
Of the 60 environmental samples, including partially eaten mangoes, guava, and areca nuts with bite marks of bats, collected from the surroundings of the residence and potential work places of the index case, none had evidence of NiV RNA detected by real-time RT-PCR. The pet rabbits and ducks of case 1 tested negative for NiV.
Only the index case was infected in the community. All remaining cases were due to nosocomial transmission in 3 different hospitals. This human-to-human transmission pattern is consistent with that of earlier outbreaks in India and Bangladesh. The majority of the cases in Malaysia and Singapore acquired NiV from infected pigs, while in the Philippines, infection was acquired from infected horses.
In this outbreak, the index case may have acquired his infection in the second half of April. Although it is impossible to establish the exact transmission event now, the most plausible explanation is direct zoonotic transmission from fruit bats, particularly Pteropus giganteus (Indian flying fox), which is abundant in the area. Although we were unable to verify this information, the fact that the index case kept pets suggests that he could have handled a NiV-infected baby bat, as April is the birthing season of bats. In the Bangladeshi NiV outbreaks, several cases from the community were attributable to bat-to-human transmission, linked to the consumption of NiV-contaminated date palm sap. In Kerala, date palms are not used for obtaining sap, and the narrow-mouthed vessels used to collect sap from coconut and Asian Palmyra palm do not allow access by bats. The absence of NiV RNA in the bat-bitten fruit collected from the index case’s house and village does not rule out zoonotic transmission from a bat to the index case.
Although several persons were in direct contact with the index case or other cases, including contact with dead bodies or bodily fluids, only those with direct exposure to the patient’s coughing appear to have contracted the disease, underscoring the occurrence of droplet-mediated human-to-human transmission. This is in contrast to the corpse-to-human transmission reported from Bangladesh.
Several additional factors likely contributed to the human-to-human transmission. These include inadequate barrier infection control measures, a lack of hand washing, the altruistic behavior of the patient companions, the poor regulation of visitors in hospitals, the extended period of waiting for procedures, and the movement of the index case in the corridor. Although the healthcare workers were trained in infection control, only a minority were using any barrier protection measures, such as a face mask and gloves. Healthcare workers or companions with adequate barrier infection control practices did not acquire NiV despite close contact with the index case.

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 17 Nov 2018 12:16

How did a bat in Kerala become a carrier for Bangladesh strain of Nipah Virus?
And if it travelled from bat to bat from Bangladesh, how come there were no outbreaks of Nipah virus all along the path?

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Re: Nipah Virus Outbreak IN Kerala-2018

Postby ramana » 17 Nov 2018 12:18

BTW I heard a radio report on a new type of plastic tent structure for isolating patients carrying infectitous diseases like ebola virus in DR Congo.


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