In the early hours of 17 May 2018, a critically ill patient was wheeled into Kozhikode’s Baby Memorial Hospital in the Indian state of Kerala. Suspecting a virus, which had not been seen before in the area, the doctors dispatched the samples to Karnataka’s Manipal Centre for Virus Research some 300 km away. The samples tested positive for Nipah virus. These results were subsequently confirmed by the National Institute of Virology (NIV), Pune. India notified the Nipah virus cases to WHO under the International Health Regulations, IHR (2005).

Nipah virus (NiV) infection is an emerging zoonosis that causes severe disease in both animals and humans. Its natural host is the fruit bat. NiV can lead to acute respiratory distress, encephalitis, and/or seizures, and can progress to coma within 24 to 48 hours. The mortality rate is estimated at between 40 and 75 percent. Early supportive care and treatment of symptoms improves survival, but there is currently no licensed treatment for Nipah. A number of immunological and drug therapies are under development.

Upon identification of the first case, the state health machinery immediately swung into action, with a team of experienced multidisciplinary experts led by the Director of the National Centre for Disease Control arriving in the affected district on 19 May. Strong political commitment was key. The Union Health Minister and the Chief Minister of Kerala state led the day-to-day situation analysis and outbreak response.

“The rapid and comprehensive response mounted both by the central and state governments clearly highlights the importance of strong health systems and such a need has never been stronger than now, especially in view of the emerging and re-emerging viruses,” said Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia Region.

Health workers worked round the clock

Key elements were a focus on infection prevention and control measures based on isolating patients, using personal protective equipment and decontaminating surfaces.

Surveillance was critical: more than 2 500 contacts of Nipah patients were monitored by the state surveillance system. Even though cases were reported from only 2 districts of Kozhikode and Malappuram in Kerala, the surveillance net was rapidly scaled up to neighboring districts as well. Advisories were issued by the Government, and updated on the Ministry website, and shared with all states. A total of 18 laboratory confirmed cases were identified, of whom 16 had died. One additional case, the person thought to have first contracted the disease, also died but could not be tested.

Information sharing also played a key role. A 24-hour helpline took queries from the concerned community, while the state government used all available channels of communication, including traditional, online and new media, and social mobilisers, to counter rumours and inform people what the risks were and how to protect themselves.

Health workers and officials all worked almost without a break, successfully preventing a further wave of human to human transmission. By mid-June, the Kerala government and the Union Health Ministry announced that the outbreak had been contained.

The outbreak response illustrates how effective, strong, and connected health systems – in close cooperation with animal health and wildlife sectors – are vital to preparedness and fast reaction.

Simultaneously, as part of R&D for Nipah, WHO is collaborating with the Indian Council of Medical Research, and research protocols are under development.

• Nipah virus disease R&D

The Kerala outbreak highlights that the risk of new and emerging diseases is real, and puts the spotlight on preparedness and strong health systems to effectively deal with such diseases.

• Nipah virus infection: India updates

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